=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265616221
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FIRST MED OF WILLIAMSBURG
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2007
-----------------------------------------------------
Last Update Date | 12/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 SECOND STREET
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-229-4141
-----------------------------------------------------
Fax | 757-229-1792
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 312 SECOND STREET
-----------------------------------------------------
City | WILLIAMSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-229-4141
-----------------------------------------------------
Fax | 757-229-1792
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | RICHARD A CAMPANA SR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 757-229-4141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0101051684VA
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 0101035546
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------