Provider Demographics
NPI:1912193061
Name:WOZENCRAFT, COLIN PRIOR (MD)
Entity Type:Individual
Prefix:
First Name:COLIN
Middle Name:PRIOR
Last Name:WOZENCRAFT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:SUITE 403
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1930
Mailing Address - Country:US
Mailing Address - Phone:804-288-2673
Mailing Address - Fax:804-285-5572
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:SUITE 403
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1930
Practice Address - Country:US
Practice Address - Phone:804-288-2673
Practice Address - Fax:804-285-5572
Is Sole Proprietor?:No
Enumeration Date:2007-09-22
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242415207R00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN