Healthcare Provider Details

I. General information

NPI: 1902248677
Provider Name (Legal Business Name): OLD DOMINION ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1139 E HIGH ST STE 203
CHARLOTTESVILLE VA
22902-4849
US

IV. Provider business mailing address

PO BOX 71819
PHILADELPHIA PA
19176-1819
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-8484
  • Fax: 434-817-8490
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential:
Phone: 786-530-3820