Provider Demographics
NPI:1619200581
Name:PULMONARY TESTING OF VIRGINIA, INC
Entity Type:Organization
Organization Name:PULMONARY TESTING OF VIRGINIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:PEMBERTON
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPFT
Authorized Official - Phone:757-466-0077
Mailing Address - Street 1:PO BOX 41154
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23541-1154
Mailing Address - Country:US
Mailing Address - Phone:757-466-0062
Mailing Address - Fax:
Practice Address - Street 1:880 KEMPSVILLE RD
Practice Address - Street 2:SUITE 1600
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3931
Practice Address - Country:US
Practice Address - Phone:757-466-0062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAFVP002Medicare PIN