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NPI Code Detail

MEDICARE: DIANA DUBOIS ALFORD P.A.

MEDICARE:   DIANA DUBOIS ALFORD  P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant996SC
2363A00000XPhysician Assistant996SC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00851397OTHERSCRR MEDICARE PTAN

Other Identifiers

General Provider Information

NPI Number : 1588663082
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANA DUBOIS ALFORD P.A.
Provider Business Mailing Address
First Line : PO BOX 602108
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-2108
Country : US
Telephone Number : 843-792-2300
Fax Number :
Provider Business Practice Location Address
First Line : 602 N MAIN ST
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29483-6627
Country : US
Telephone Number : 843-876-2121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 05/11/2016

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Directions to “ DIANA DUBOIS ALFORD P.A.” Practice Location

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