Provider Demographics
NPI:1770765620
Name:VIRGINIA MEDICAL GROUP, PC
Entity type:Organization
Organization Name:VIRGINIA MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:TALBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-520-0040
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 1:306 WEAVER AVE
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1232
Practice Address - Country:US
Practice Address - Phone:434-634-0094
Practice Address - Fax:804-520-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACN0649OtherMEDICARE RAILROAD
VAC03269Medicare PIN