Provider Demographics
NPI:1043358328
Name:WILLIAMSBURG GASTROENTEROLOGY, PC
Entity type:Organization
Organization Name:WILLIAMSBURG GASTROENTEROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:O
Authorized Official - Last Name:CONVERSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-221-0750
Mailing Address - Street 1:457 MCLAWS CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5645
Mailing Address - Country:US
Mailing Address - Phone:757-221-0750
Mailing Address - Fax:757-345-3243
Practice Address - Street 1:457 MCLAWS CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5645
Practice Address - Country:US
Practice Address - Phone:757-221-0750
Practice Address - Fax:757-345-3243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty