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General NPI Number Information
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NPI Number | 1326302563
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Entity Type | Individual
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Provider Name | ALBERT GORDON PAVALONIS D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 11/09/2022
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Provider Practice Location Address
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Address Line | 2410 ATHERHOLT RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-2148
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Country | US
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Telephone | 434-200-5299
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Fax | 434-200-2386
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Provider Business Mailing Address
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Address Line | 1735 CALAIS TRAIL
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City | POWHATAN
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State | VA
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Zip | 23139-4523
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Country | US
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Telephone | 540-588-0521
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 0102205543
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License Number State | VA
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