Provider Demographics
NPI:1720015852
Name:COLONIAL ORTHOPAEDICS, INC
Entity Type:Organization
Organization Name:COLONIAL ORTHOPAEDICS, INC
Other - Org Name:COLONIAL ORTHOPAEDICS & VA OSTEOPOROSIS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-526-5888
Mailing Address - Street 1:131 JENNICK DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-4905
Mailing Address - Country:US
Mailing Address - Phone:804-526-5888
Mailing Address - Fax:804-526-5401
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860-2719
Practice Address - Country:US
Practice Address - Phone:804-541-2979
Practice Address - Fax:804-452-1270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034297207X00000X
VA0101036726207X00000X
VA0101226595207XS0106X
VA0101231604207XS0114X
VA0101237849207XS0117X
VA0101045456207XX0004X
VA0101052925207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle SurgeryGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006409270Medicaid
VA285195OtherANTHEM-PRAKASH
VA006409261Medicaid
VA006409288Medicaid
VA010185220Medicaid
VA010174643Medicaid
VA285196OtherANTHEM-SARAIYA
VA285454335OtherANTHEM-DHILLON
VA454337OtherANTHEM-SRIVASTAVA
VA006409211Medicaid
VA006409253Medicaid
VA285194OtherANTHEM-BHULLER
VA285454335OtherANTHEM-DHILLON
VAH40767Medicare UPIN
VA010185220Medicaid
VA006409211Medicaid
VA006409253Medicaid
VA006409270Medicaid
VA285194OtherANTHEM-BHULLER
VAH14865Medicare UPIN