1912561887 NPI number — MS. MOLLY ELIZABETH PALLAVICINI L.P.C

Table of content: MS. MOLLY ELIZABETH PALLAVICINI L.P.C (NPI 1912561887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912561887 NPI number — MS. MOLLY ELIZABETH PALLAVICINI L.P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALLAVICINI
Provider First Name:
MOLLY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.P.C
Provider Gender Code:
F

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:
1912561887
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ROCKBRIDGE AREA HEALTH CENTER
Provider Second Line Business Mailing Address:
25 NORTHRIDGE LANE
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-464-8700
Provider Business Mailing Address Fax Number:
540-464-1323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROCKBRIDGE AREA HEALTH CENTER
Provider Second Line Business Practice Location Address:
25 NORTHRIDGE LANE
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-464-8700
Provider Business Practice Location Address Fax Number:
540-464-1323
Provider Enumeration Date:
04/26/2019

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: 101YP2500X , with the licence number:  0701008218 , 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)





Copyright © 2007-2024 www.npivalidator.com