Provider Demographics
NPI:1720388275
Name:VIRGINIA MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:VIRGINIA MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-526-0682
Mailing Address - Street 1:2905 BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2400
Mailing Address - Country:US
Mailing Address - Phone:804-520-0040
Mailing Address - Fax:804-520-0043
Practice Address - Street 1:213 TEMPLE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2827
Practice Address - Country:US
Practice Address - Phone:804-526-0682
Practice Address - Fax:804-518-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACN0649OtherMEDICARE RAILROAD
VAC03269Medicare UPIN