MEDICARE: VIRGINIA ALLERGY TREATMENT CENTER PLLC

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

General Provider Information

NPI Number	:	1770452831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIRGINIA ALLERGY TREATMENT CENTER PLLC

Provider Business Mailing Address
First Line	:	812 MOOREFIELD PARK DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3684
Country	:	US
Telephone Number	:	757-746-9974
Fax Number	:

Provider Business Practice Location Address
First Line	:	812 MOOREFIELD PARK DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-3684
Country	:	US
Telephone Number	:	757-746-9974
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGING MEMBER
Name	:	NICHOLAS KLAIBER
Credential	:	MD
Telephone Number	:	757-746-9974

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	11/05/2025

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