Healthcare Provider Details

I. General information

NPI: 1164528881
Provider Name (Legal Business Name): VIRGINIA MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 BOULEVARD
COLONIAL HEIGHTS VA
23834-2400
US

IV. Provider business mailing address

2905 BOULEVARD
COLONIAL HEIGHTS VA
23834-2400
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-0682
  • Fax: 804-520-0043
Mailing address:
  • Phone: 804-526-0682
  • Fax: 804-520-0043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateVA

VIII. Authorized Official

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