Provider Demographics
NPI:1053423145
Name:INTERNAL MEDICINE ASSOCIATES OF VIRGINIA, LTD
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF VIRGINIA, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-285-5882
Mailing Address - Street 1:7603 FOREST AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4942
Mailing Address - Country:US
Mailing Address - Phone:804-282-2580
Mailing Address - Fax:804-285-4823
Practice Address - Street 1:7603 FOREST AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4942
Practice Address - Country:US
Practice Address - Phone:804-282-2580
Practice Address - Fax:804-285-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA025394OtherANTHEM BLUE CROSS PROVIDE
VA025394OtherANTHEM BLUE CROSS PROVIDE