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General NPI Number Information
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NPI Number | 1225079650
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Entity Type | Organization
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Legal Business Name | WILLIAMSBURG EMERGENCY PHYSICIANS
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 04/03/2020
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Provider Practice Location Address
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Address Line | 100 SENTARA CIR
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-5713
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Country | US
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Telephone | 757-221-0055
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2915
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City | WILLIAMSBURG
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State | VA
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Zip | 23187-2915
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Country | US
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Telephone | 757-221-0055
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Fax | 757-221-8085
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Authorized Official
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Title or Position | AO
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Name | COURTNEY ZYDRON
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Credential | MD
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Telephone | 757-719-9003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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