Provider Demographics
NPI:1215273206
Name:EMILY ASHLEY
Entity type:Organization
Organization Name:EMILY ASHLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:DR
Authorized Official - First Name:SILKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-439-3859
Mailing Address - Street 1:104 SEVEN PINES AVE
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-1600
Mailing Address - Country:US
Mailing Address - Phone:804-439-3859
Mailing Address - Fax:
Practice Address - Street 1:3335 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9214
Practice Address - Country:US
Practice Address - Phone:804-765-5445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215273206Medicaid
VAC140Medicare PIN