Provider Demographics
NPI:1396970281
Name:ALLERGY & ASTHMA SPECIALISTS OF VIRGINIA PC
Entity type:Organization
Organization Name:ALLERGY & ASTHMA SPECIALISTS OF VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAFFERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-559-8055
Mailing Address - Street 1:7489 RIGHT FLANK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-3845
Mailing Address - Country:US
Mailing Address - Phone:804-559-8055
Mailing Address - Fax:804-559-6920
Practice Address - Street 1:7489 RIGHT FLANK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3845
Practice Address - Country:US
Practice Address - Phone:804-559-8055
Practice Address - Fax:804-559-6920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043309107OtherINDIVIDUAL NPI
VA1932130531OtherINDIVIDUAL NPI
VAC10967Medicare PIN