Provider Demographics
NPI:1215298724
Name:AIDS/HIV SERVICES GROUP INC.
Entity type:Organization
Organization Name:AIDS/HIV SERVICES GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-979-7714
Mailing Address - Street 1:315 10TH ST NE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5316
Mailing Address - Country:US
Mailing Address - Phone:434-979-7714
Mailing Address - Fax:434-984-0249
Practice Address - Street 1:315 10TH ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5316
Practice Address - Country:US
Practice Address - Phone:434-979-7714
Practice Address - Fax:434-984-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215298724Medicaid
VA1710208608Medicaid
VA1052403287Medicaid