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Organization

COLONY DIAGNOSTICS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TIMOTHY DELONG (NPI REPRESENTATIVE)
(210) 598-2800
Entity
Organization

Contact information

Practice address
11533 BUSY ST # 305, NORTH CHESTERFIELD, VA 23236-4073
(540) 595-0795
Mailing address
11533 BUSY ST # 305, NORTH CHESTERFIELD, VA 23236-4073

Taxonomy

Speciality
Code
Description
License number
State
2084N0600X
Clinical Neurophysiology Physician
Primary
246ZE0600X
Electroneurodiagnostic Specialist/Technologist

Other

Enumeration date
08/29/2017
Last updated
11/17/2017
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