Healthcare Provider Details

I. General information

NPI: 1457323800
Provider Name (Legal Business Name): JOHN OWNE COLONNA II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8620
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8620
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-1600
  • Fax: 757-625-0433
Mailing address:
  • Phone: 757-395-1600
  • Fax: 757-625-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0101049364
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: