MEDICARE: PULMONARY TESTING OF VIRGINIA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1619200581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY TESTING OF VIRGINIA, INC

Provider Business Mailing Address
First Line	:	PO BOX 41154
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23541-1154
Country	:	US
Telephone Number	:	757-466-0062
Fax Number	:

Provider Business Practice Location Address
First Line	:	880 KEMPSVILLE RD
Second Line	:	SUITE 1600
City	:	NORFOLK
State	:	VA
Zip	:	23502-3931
Country	:	US
Telephone Number	:	757-466-0062
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS PEMBERTON BROWN
Credential	:	RPFT
Telephone Number	:	757-466-0077

Provider Enumeration Date	:	09/10/2009
Last Update Date	:	09/10/2009

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