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Organization

VILLAGE DOCTOR, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN EDWARD BRADY MD (PRESIDENT)
(757) 223-0124
Entity
Organization

Contact information

Practice address
10222 WARWICK BLVD, NEWPORT NEWS, VA 23601-4029
(757) 223-0124
(757) 223-0127
Mailing address
860 OMNI BLVD STE 101, NEWPORT NEWS, VA 23606-4430
(757) 232-8769
(757) 232-8875

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0591153-2
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
49D1014015
CLIA LAB NUMBER
VA
Enumeration date
02/01/2007
Last updated
03/19/2021
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