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General NPI Number Information
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NPI Number | 1700968393
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Entity Type | Organization
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Legal Business Name | PETERSBURG UROLOGICAL ASSOCIATES LTD
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 12/01/2008
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Provider Practice Location Address
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Address Line | 430 CLAIRMONT COURT SUITE 214
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-1770
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Country | US
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Telephone | 804-520-5580
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Fax | 804-520-5583
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Provider Business Mailing Address
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Address Line | 430 CLAIRMONT COURT SUITE 214
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-1770
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Country | US
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Telephone | 804-520-5580
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Fax | 804-520-5583
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Authorized Official
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Title or Position | PRESIDENT
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Name | H ALAN BIGLEY JR.
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Credential | MD
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Telephone | 804-732-7780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 0101019205
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License Number State | VA
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