Healthcare Provider Details

I. General information

NPI: 1356394845
Provider Name (Legal Business Name): JAMES R ALIG PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 BUFORD RD
NORTH CHESTERFIELD VA
23235-3422
US

IV. Provider business mailing address

2602 BUFORD RD
NORTH CHESTERFIELD VA
23235-3422
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-8806
  • Fax: 804-272-2909
Mailing address:
  • Phone: 804-272-8806
  • Fax: 804-272-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001517
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: