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 STE 100, COLONIAL HEIGHTS, VA 23834-2986
(804) 526-5888
(804) 526-5401
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101034297
VA
207X00000X
Orthopaedic Surgery Physician
Primary
0101036726
VA
207XS0106X
Orthopaedic Hand Surgery Physician
0101226595
VA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
0101231604
VA
207XS0117X
Orthopaedic Surgery of the Spine Physician
0101237849
VA
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
0101045456
VA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
0101052925
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010216109
—
VA
01
—
183282
ANTHEM-BHULLER
VA
Enumeration date
06/26/2006
Last updated
06/11/2019
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