MEDICARE: ALPHONZO SMALLS PA-C

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
1	246XC2903X	Vascular Specialist/Technologist Cardiovascular	101858	VA
2	363AM0700X	Medical Physician Assistant	0110-004964	VA

General Provider Information

NPI Number	:	1861751372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALPHONZO SMALLS PA-C

Provider Business Mailing Address
First Line	:	2101 PARKS AVE STE 305
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-4185
Country	:	US
Telephone Number	:	757-749-2308
Fax Number	:	757-447-3988

Provider Business Practice Location Address
First Line	:	2101 PARKS AVE STE 305
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-4185
Country	:	US
Telephone Number	:	757-749-2308
Fax Number	:	757-447-3988

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	02/28/2026

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Directions to “ ALPHONZO SMALLS PA-C” Practice Location

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