Healthcare Provider Details

I. General information

NPI: 1104955467
Provider Name (Legal Business Name): UROLOGY OF VIRGINIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 HARTFORD RD
HAMPTON VA
23666-2409
US

IV. Provider business mailing address

PO BOX 13208
NORFOLK VA
23506-0208
US

V. Phone/Fax

Practice location:
  • Phone: 757-827-7430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: LORI DELBRIDGE
Title or Position: CBO DIRECTOR
Credential:
Phone: 757-466-3410