Healthcare Provider Details

I. General information

NPI: 1295278968
Provider Name (Legal Business Name): COLONIAL ORTHOPAEDICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2016
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 FAIRVIEW DR
FRANKLIN VA
23851-1226
US

IV. Provider business mailing address

325 CHARLES H DIMMOCK PKWY SUITE 100
COLONIAL HEIGHTS VA
23834-2986
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-5888
  • Fax: 804-526-5401
Mailing address:
  • Phone: 804-526-5888
  • Fax: 804-526-5401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101257013
License Number StateVA

VIII. Authorized Official

Name: SHARAD SARAIYA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 804-571-5106