Healthcare Provider Details

I. General information

NPI: 1093855983
Provider Name (Legal Business Name): MARY L COLFER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 FOREST AVE STE 410
RICHMOND VA
23229-4946
US

IV. Provider business mailing address

7611 FOREST AVE STE 410
RICHMOND VA
23229-4946
US

V. Phone/Fax

Practice location:
  • Phone: 804-773-7611
  • Fax: 804-324-3434
Mailing address:
  • Phone: 47-737-6118
  • Fax: 804-324-3434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number223345-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101056632
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101056632
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: