Organization
COLONIAL ORTHOPAEDICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BAILEY (CREDENTIALING SPECIALIST)
(804) 571-5106
Entity
Organization
Contact information
Practice address
325 CHARLES H DIMMOCK PKWY STE 100, COLONIAL HEIGHTS, VA 23834-2986
(804) 526-5888
(804) 526-5401
Mailing address
325 CHARLES H DIMMOCK PKWY, SUITE 100, COLONIAL HEIGHTS, VA 23834-2986
(804) 526-5888
(804) 526-5401
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101036726
VA
207X00000X
Orthopaedic Surgery Physician
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
0101257013
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053778845
—
VA
Enumeration date
01/25/2016
Last updated
06/11/2019
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