1336111434 NPI number — MS. JERRI ALLEY M.D.

Table of content: (NPI 1598045064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336111434 NPI number — MS. JERRI ALLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEY
Provider First Name:
JERRI
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALEXIOU
Provider Other First Name:
JERRI
Provider Other Middle Name:
ALLEY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336111434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4549 SPOTSWOOD TRAIL
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
PENN LAIRD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-433-8700
Provider Business Mailing Address Fax Number:
540-433-8080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4549 SPOTSWOOD TRAIL
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
PENN LAIRD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22846
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-433-8700
Provider Business Practice Location Address Fax Number:
540-433-8080
Provider Enumeration Date:
02/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  0101231136 , 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: 5727789 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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