Provider Demographics
NPI:1801979539
Name:COLONIAL OB-GYN ASSOCIATES LTD
Entity type:Organization
Organization Name:COLONIAL OB-GYN ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHWAYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-874-2790
Mailing Address - Street 1:716 DENBIGH BLVD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4414
Mailing Address - Country:US
Mailing Address - Phone:757-874-2790
Mailing Address - Fax:757-874-6758
Practice Address - Street 1:716 DENBIGH BLVD
Practice Address - Street 2:SUITE E-2
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4414
Practice Address - Country:US
Practice Address - Phone:757-874-2795
Practice Address - Fax:757-874-6758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6232019Medicaid
VA1912970302OtherNPI NUMBER
VAB07243Medicare UPIN
VA1912970302OtherNPI NUMBER
VAI54245Medicare UPIN