Provider Demographics
NPI:1881884757
Name:VIRGINIA ALLERGY ASTHMA INSTITUTE PC
Entity type:Organization
Organization Name:VIRGINIA ALLERGY ASTHMA INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILSECK
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD MD
Authorized Official - Phone:804-794-9477
Mailing Address - Street 1:13510 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2626
Mailing Address - Country:US
Mailing Address - Phone:804-794-9477
Mailing Address - Fax:804-794-1793
Practice Address - Street 1:13510 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2626
Practice Address - Country:US
Practice Address - Phone:804-794-9477
Practice Address - Fax:804-794-1793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021733207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB61112Medicare UPIN