Healthcare Provider Details

I. General information

NPI: 1972550226
Provider Name (Legal Business Name): RICHARD THOMAS ALIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 09/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1730 SAINT JULIAN PLACE
COLUMBIA SC
29204-2410
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-779-2005
  • Fax: 803-765-0007
Mailing address:
  • Phone: 803-296-7305
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6287
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number6287
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: