Provider Demographics
NPI:1992857791
Name:SIEVERT, WILLIAM ALVIN
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ALVIN
Last Name:SIEVERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:948 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4517
Mailing Address - Country:US
Mailing Address - Phone:757-395-4279
Mailing Address - Fax:757-395-4279
Practice Address - Street 1:948 MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4517
Practice Address - Country:US
Practice Address - Phone:757-395-4279
Practice Address - Fax:757-395-4279
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA113922-0000-6599171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor