MEDICARE: VIRGINIA MEDICAL GROUP PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207RC0000X	Cardiovascular Disease Physician	VA
2	207RP1001X	Pulmonary Disease Physician	VA
3	2084N0400X	Neurology Physician	VA
4	207UN0901X	Nuclear Cardiology Physician	VA
5	174400000X	Specialist	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN0649	OTHER	VA	MEDICARE RAILROAD

General Provider Information

NPI Number	:	1164528881
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA MEDICAL GROUP PC

Provider Business Mailing Address
First Line	:	2905 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2400
Country	:	US
Telephone Number	:	804-526-0682
Fax Number	:	804-520-0043

Provider Business Practice Location Address
First Line	:	2905 BOULEVARD
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-2400
Country	:	US
Telephone Number	:	804-526-0682
Fax Number	:	804-520-0043

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	PATRICIA H TALBOTT
Credential	:	RN R.D.C.S.
Telephone Number	:	804-526-0682

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/21/2022

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Directions to “VIRGINIA MEDICAL GROUP PC ” Practice Location

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