Provider Demographics
NPI:1700968393
Name:PETERSBURG UROLOGICAL ASSOCIATES LTD
Entity Type:Organization
Organization Name:PETERSBURG UROLOGICAL ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:H
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BIGLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-732-7780
Mailing Address - Street 1:430 CLAIRMONT COURT
Mailing Address - Street 2:SUITE 214
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1770
Mailing Address - Country:US
Mailing Address - Phone:804-520-5580
Mailing Address - Fax:804-520-5583
Practice Address - Street 1:430 CLAIRMONT COURT
Practice Address - Street 2:SUITE 214
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1770
Practice Address - Country:US
Practice Address - Phone:804-520-5580
Practice Address - Fax:804-520-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101019205208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACM6794Medicare PIN
VAC00653Medicare PIN