Healthcare Provider Details

I. General information

NPI: 1497733000
Provider Name (Legal Business Name): ALICIA C DAGLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 PANTOPS MOUNTAIN PL SUITE 200
CHARLOTTESVILLE VA
22911-4601
US

IV. Provider business mailing address

1490 PANTOPS MOUNTAIN PL SUITE 200
CHARLOTTESVILLE VA
22911-4601
US

V. Phone/Fax

Practice location:
  • Phone: 434-979-4440
  • Fax: 434-979-4441
Mailing address:
  • Phone: 434-979-4440
  • Fax: 434-979-4441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101055269
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: