Provider Demographics
NPI:1639229818
Name:PRINCE WILLIAM UROLOGY ASSOCIATES LTD
Entity Type:Organization
Organization Name:PRINCE WILLIAM UROLOGY ASSOCIATES LTD
Other - Org Name:DRS GIL MONTERO & SEHN LTD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OAKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-393-0700
Mailing Address - Street 1:8525 ROLLING RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3648
Mailing Address - Country:US
Mailing Address - Phone:703-393-0700
Mailing Address - Fax:703-393-0661
Practice Address - Street 1:8525 ROLLING RD STE 220
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3648
Practice Address - Country:US
Practice Address - Phone:703-393-0700
Practice Address - Fax:703-393-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010198976Medicaid
VA1427151612Medicaid
VA007510306Medicaid
VAC15002Medicare PIN
VA015809P70Medicare PIN
VA008532G70Medicare PIN
VAH62357Medicare UPIN
VA007510306Medicaid
VAC00570Medicare PIN
VA341950430Medicare PIN
VA010198976Medicaid
VA1427151612Medicaid