First Colonial Urological Ass

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

0101018138 Issued in VA

Legal business name

FIRST COLONIAL UROLOGICAL ASS

Practice address

4501 B Witchduck Rd
VA Beach, VA 23455

Phone

(757) 499-4932

Fax

(757) 490-6693

NPI assigned

Aug 28, 2006

Last updated

Feb 20, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charles Stanley Davis Jr., MD

Title

President of Corp

Phone

(757) 499-4932

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1881702058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4501 N WITCHDUCK RD",
            "city": "VA BEACH",
            "state": "VA",
            "postal_code": "23455",
            "telephone_number": "757-499-4932",
            "fax_number": "757-490-6693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4501 B WITCHDUCK RD",
            "city": "VA BEACH",
            "state": "VA",
            "postal_code": "23455",
            "telephone_number": "757-499-4932",
            "fax_number": "757-490-6693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST COLONIAL UROLOGICAL ASS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-28",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "STANLEY",
        "authorized_official_title_or_position": "PRESIDENT OF CORP",
        "authorized_official_telephone_number": "757-499-4932",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "VA",
            "license": "0101018138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7535902",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC",
            "identifier": "016603",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Urology Physician in VA Beach, VA
• Providers in VA Beach, VA by specialty
• Urology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.