Healthcare Provider Details

I. General information

NPI: 1275168247
Provider Name (Legal Business Name): WILLIAMSBURG EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 03/10/2020
Certification Date: 03/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SENTARA CIR
WILLIAMSBURG VA
23188-5713
US

IV. Provider business mailing address

PO BOX 844535
BOSTON MA
02284-4535
US

V. Phone/Fax

Practice location:
  • Phone: 757-984-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY TERRY ZYDRON
Title or Position: PRESIDENT
Credential:
Phone: 757-719-1141