=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124384623
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRI-CITIES INFECTIOUS DISEASE ASSOCIATES, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2012
-----------------------------------------------------
Last Update Date | 07/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 505 N 6TH AVE
-----------------------------------------------------
City | HOPEWELL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23860-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-452-2449
-----------------------------------------------------
Fax | 804-454-2870
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 505 N 6TH AVE
-----------------------------------------------------
City | HOPEWELL
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23860-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-452-2449
-----------------------------------------------------
Fax | 804-454-2870
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. REBECCA ALEJANDRINO LITTAUA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 804-452-2449
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------