Provider Demographics
NPI:1760576607
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:P
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPFT
Authorized Official - Phone:757-285-4157
Mailing Address - Street 1:4849 BRIGADOON DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-1912
Mailing Address - Country:US
Mailing Address - Phone:757-285-4157
Mailing Address - Fax:757-464-0941
Practice Address - Street 1:4849 BRIGADOON DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-1912
Practice Address - Country:US
Practice Address - Phone:757-285-4157
Practice Address - Fax:757-464-0941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA49D0889263291U00000X
VA293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004996968Medicaid
VA190001405Medicare PIN
VA004996968Medicaid