Healthcare Provider Details

I. General information

NPI: 1609168905
Provider Name (Legal Business Name): DOPPLER ALLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2011
Last Update Date: 06/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4772 EUCLID RD STE D
VIRGINIA BCH VA
23462-3800
US

IV. Provider business mailing address

4772 EUCLID RD STE D
VIRGINIA BCH VA
23462-3800
US

V. Phone/Fax

Practice location:
  • Phone: 757-685-7232
  • Fax:
Mailing address:
  • Phone: 757-685-7232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number134552-8080
License Number StateVA

VIII. Authorized Official

Name: SHENEKIA M BAKER
Title or Position: MANAGER
Credential: RVT
Phone: 757-685-7232