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		VA
2	291U00000X	Clinical Medical Laboratory	49D0889263	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760576607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY TESTING OF VIRGINIA, INC

Provider Business Mailing Address
First Line	:	4849 BRIGADOON DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1912
Country	:	US
Telephone Number	:	757-285-4157
Fax Number	:	757-464-0941

Provider Business Practice Location Address
First Line	:	4849 BRIGADOON DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-1912
Country	:	US
Telephone Number	:	757-285-4157
Fax Number	:	757-464-0941

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS P BROWN
Credential	:	RPFT
Telephone Number	:	757-285-4157

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	06/28/2012

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