Healthcare Provider Details

I. General information

NPI: 1225079650
Provider Name (Legal Business Name): WILLIAMSBURG EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 04/03/2020
Certification Date: 04/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SENTARA CIR
WILLIAMSBURG VA
23188-5713
US

IV. Provider business mailing address

PO BOX 2915
WILLIAMSBURG VA
23187-2915
US

V. Phone/Fax

Practice location:
  • Phone: 757-221-0055
  • Fax:
Mailing address:
  • Phone: 757-221-0055
  • Fax: 757-221-8085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY ZYDRON
Title or Position: AO
Credential: MD
Phone: 757-719-9003