Healthcare Provider Details

I. General information

NPI: 1700968393
Provider Name (Legal Business Name): PETERSBURG UROLOGICAL ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 CLAIRMONT COURT SUITE 214
COLONIAL HEIGHTS VA
23834-1770
US

IV. Provider business mailing address

430 CLAIRMONT COURT SUITE 214
COLONIAL HEIGHTS VA
23834-1770
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-5580
  • Fax: 804-520-5583
Mailing address:
  • Phone: 804-520-5580
  • Fax: 804-520-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101019205
License Number StateVA

VIII. Authorized Official

Name: H ALAN BIGLEY JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 804-732-7780