1013259563 NPI number — ALFREDO S. SISON JR MD LLC

Table of content: (NPI 1013259563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013259563 NPI number — ALFREDO S. SISON JR MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALFREDO S. SISON JR MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013259563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2601 RADNOR PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLOTHIAN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23113-6496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-379-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N ROBINSON ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23220-4460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-379-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SISON
Authorized Official First Name:
ALFREDO
Authorized Official Middle Name:
S
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
804-379-2000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  0101058391 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 118318 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: G83949 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 007114982 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".