MEDICARE: ALLERGY & ASTHMA SPECIALISTS OF VIRGINIA PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1043309107	OTHER	VA	INDIVIDUAL NPI
2	1932130531	OTHER	VA	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1396970281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLERGY & ASTHMA SPECIALISTS OF VIRGINIA PC

Provider Business Mailing Address
First Line	:	7489 RIGHT FLANK RD
Second Line	:	SUITE 300
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3845
Country	:	US
Telephone Number	:	804-559-8055
Fax Number	:	804-559-6920

Provider Business Practice Location Address
First Line	:	7489 RIGHT FLANK RD
Second Line	:	SUITE 300
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3845
Country	:	US
Telephone Number	:	804-559-8055
Fax Number	:	804-559-6920

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAMELA J DAFFERN
Credential	:	MD
Telephone Number	:	804-559-8055

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	08/03/2012

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