Healthcare Provider Details

I. General information

NPI: 1447238209
Provider Name (Legal Business Name): JOHN BARTON D'ALESSANDRO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

IV. Provider business mailing address

1900 ELECTRIC RD
SALEM VA
24153-7474
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110840817
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840817
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: