Basic Information
Provider Information
NPI: 1780631010
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COOMBS
FirstName: ALICE
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: TOLBERT
OtherFirstName: ALICE
OtherMiddleName: A
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: M.D.
OtherLastNameType: 1
Mailing Information
Address1: PO BOX 91734
Address2:  
City: RICHMOND
State: VA
PostalCode: 232911734
CountryCode: US
TelephoneNumber: 8043586100
FaxNumber: 8043427619
Practice Location
Address1: 1250 E MARSHALL ST
Address2: ANESTHESIOLOGY
City: RICHMOND
State: VA
PostalCode: 232985051
CountryCode: US
TelephoneNumber: 8048282207
FaxNumber: 8048288300
Other Information
ProviderEnumerationDate: 05/30/2006
LastUpdateDate: 01/17/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LC0200X0101260797VAY Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine

No ID Information.


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