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General NPI Number Information
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NPI Number | 1912056771
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Entity Type | Individual
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Provider Name | ALFRED SPENCER GERVIN M.D., MBA
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9702 GAYTON RD # 327
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City | RICHMOND
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State | VA
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Zip | 23238-4907
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Country | US
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Telephone | 804-784-9012
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Fax | 804-784-9016
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Provider Business Mailing Address
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Address Line | 1 ROADS END LN
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City | RICHMOND
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State | VA
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Zip | 23238-6109
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Country | US
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Telephone | 804-784-9012
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Fax | 804-784-9016
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 36192
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License Number State | VA
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