Healthcare Provider Details

I. General information

NPI: 1801363767
Provider Name (Legal Business Name): MORGAN STUART ALLEN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD STE 210
RICHMOND VA
23226-1922
US

IV. Provider business mailing address

5855 BREMO RD STE 210
RICHMOND VA
23226-1922
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7066
  • Fax: 804-673-9531
Mailing address:
  • Phone: 804-287-7066
  • Fax: 804-673-9531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number0024176601
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: