Provider Demographics
NPI:1447353768
Name:ALLIGOOD, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:ALLIGOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 VALLEY GATEWAY BLVD
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6858
Mailing Address - Country:US
Mailing Address - Phone:540-400-6676
Mailing Address - Fax:540-400-6670
Practice Address - Street 1:3960 VALLEY GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6858
Practice Address - Country:US
Practice Address - Phone:540-400-6676
Practice Address - Fax:540-400-6670
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046915207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005620252Medicaid
WV3810001075Medicaid
VA005620236Medicaid
080007815Medicare PIN
WV3810001075Medicaid