Provider Demographics
NPI:1073818720
Name:DUNLEAVY, ALICIA K (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:K
Last Name:DUNLEAVY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-003505363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV1549BOtherMEDICARE
VA1073818720OtherHUMANA MEDICARE
VA1073818720OtherGATEWAY
VA1073818720OtherTRICARE
VA1073818720OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1073818720OtherINTOTAL
VA1073818720OtherCCC VIRGINIA PREMIER
VA1073818720OtherMEDICAID QMB
VA1073818720OtherAETNA
VAP01520215OtherRAILROAD MEDICARE
VA1073818720OtherOPTIMA HEALTH PLAN
VA1073818720OtherUMWA
VA1073818720OtherANTHEM MEDIGAP