Provider Demographics
NPI:1093855983
Name:COLFER, MARY L (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:COLFER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7611 FOREST AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4946
Mailing Address - Country:US
Mailing Address - Phone:047-737-6118
Mailing Address - Fax:804-324-3434
Practice Address - Street 1:7611 FOREST AVE STE 410
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-773-7611
Practice Address - Fax:804-324-3434
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223345-1207P00000X
VA0101056632207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02212980Medicaid
RA2212Medicare ID - Type Unspecified
NY02212980Medicaid