Provider Demographics
NPI:1669631560
Name:FIRST MED OF WILLIAMSBURG
Entity Type:Organization
Organization Name:FIRST MED OF WILLIAMSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CAMPANA
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-229-4141
Mailing Address - Street 1:312 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-4528
Mailing Address - Country:US
Mailing Address - Phone:757-229-4141
Mailing Address - Fax:
Practice Address - Street 1:312 2ND ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-4528
Practice Address - Country:US
Practice Address - Phone:757-229-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035546207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004203OtherANTHEM PROVIDER NUMBER
VTB09476Medicare UPIN
VA004203OtherANTHEM PROVIDER NUMBER