MEDICARE: ALYSON TROVATO COOPER P.A.-C

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	363AM0700X	Medical Physician Assistant	0110003995	VA

General Provider Information

NPI Number	:	1508117367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSON TROVATO COOPER P.A.-C

Provider Business Mailing Address
First Line	:	1201 LAKE JAMES DRIVE
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 LAKE JAMES DR
Second Line	:	SUITE 200
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6780
Country	:	US
Telephone Number	:	757-523-0022
Fax Number	:	888-411-0570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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