Healthcare Provider Details

I. General information

NPI: 1902104094
Provider Name (Legal Business Name): ALOUF AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 APPERSON DR
SALEM VA
24153-7217
US

IV. Provider business mailing address

1602 APPERSON DR
SALEM VA
24153-7217
US

V. Phone/Fax

Practice location:
  • Phone: 540-375-9070
  • Fax: 540-375-9076
Mailing address:
  • Phone: 540-375-9070
  • Fax: 540-375-9076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number0101-230-957
License Number StateVA

VIII. Authorized Official

Name: GREGORY ALAN ALOUF
Title or Position: MD
Credential:
Phone: 540-375-9070