Healthcare Provider Details

I. General information

NPI: 1831102938
Provider Name (Legal Business Name): ALICIA D WOOD P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 03/31/2014
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

9605 DOVE HOLLOW LN
GLEN ALLEN VA
23060-3257
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-8806
  • Fax: 804-272-2909
Mailing address:
  • Phone: 804-943-5871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002327
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: