Healthcare Provider Details

I. General information

NPI: 1265616221
Provider Name (Legal Business Name): FIRST MED OF WILLIAMSBURG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 SECOND STREET
WILLIAMSBURG VA
23185
US

IV. Provider business mailing address

312 SECOND STREET
WILLIAMSBURG VA
23185
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-4141
  • Fax: 757-229-1792
Mailing address:
  • Phone: 757-229-4141
  • Fax: 757-229-1792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101051684VA
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101035546
License Number StateVA

VIII. Authorized Official

Name: RICHARD A CAMPANA SR.
Title or Position: PHYSICIAN
Credential: MD
Phone: 757-229-4141