Healthcare Provider Details

I. General information

NPI: 1275302481
Provider Name (Legal Business Name): ALLISON DELAWDER P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2023
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LEW DEWITT BLVD # B
WAYNESBORO VA
22980-1663
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110009813
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: