Healthcare Provider Details

I. General information

NPI: 1992857791
Provider Name (Legal Business Name): MR. WILLIAM ALVIN SIEVERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

948 MARYLAND AVE
VIRGINIA BEACH VA
23451-4517
US

IV. Provider business mailing address

948 MARYLAND AVE
VIRGINIA BEACH VA
23451-4517
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-4279
  • Fax: 757-395-4279
Mailing address:
  • Phone: 757-395-4279
  • Fax: 757-395-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number113922-0000-6599
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: