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General NPI Number Information
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NPI Number | 1689600447
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Entity Type | Organization
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Legal Business Name | COLONIAL ORTHOPAEDICS, INC
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 325 CHARLES H DIMMOCK PKWY STE 100
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2986
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Country | US
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Telephone | 804-526-5888
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Fax | 804-526-5401
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Provider Business Mailing Address
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Address Line | 325 CHARLES H DIMMOCK PKWY STE 100
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2986
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Country | US
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Telephone | 804-526-5888
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Fax | 804-526-5401
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | JENNIFER BAILEY
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Credential |
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Telephone | 804-571-5106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number | 0101226595
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 0101231604
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 0101237849
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number | 0101045456
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 0101052925
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 0101036726
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License Number State | VA
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