Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 0101044977 | VA |
NPI | 1255442174 |
---|---|
Provider Name | Dr. Lawrence B Colen |
First Address | Norfolk, VA 23502-2964 |
Second Address | Norfolk, VA 23502-2964 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 13/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0016493775 | VA SALES TAX NUMBER (01) | |
006900151 | (05) | VA |
0101044977 | VA LICENSE (01) | VA |
024565 | BCBS (01) | |
15781 | SENTARA (01) | |
2218489 | AETNA (01) | |
24004907 | RAILROAD MEDICARE (01) | |
295242 | BCBS (01) | VA |
295243 | BCBS (01) | VA |
3755 | ASPRS (01) | |
541706870 | TAX ID (01) | |
890686C | (05) | NC |
AC7911969 | DEA NUMBER (01) | |
C08782 | MEDICARE GROUP (01) | |
E71399 | (02) |