Organization
FIRST COLONIAL UROLOGICAL ASS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES STANLEY DAVIS JR. MD (PRESIDENT OF CORP)
(757) 499-4932
Entity
Organization
Contact information
Practice address
4501 B WITCHDUCK RD, VA BEACH, VA 23455
(757) 499-4932
(757) 490-6693
Mailing address
4501 N WITCHDUCK RD, VA BEACH, VA 23455
(757) 499-4932
(757) 490-6693
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101018138
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016603
BC
VA
05
—
7535902
—
VA
Enumeration date
08/28/2006
Last updated
02/20/2008
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