Provider Demographics
NPI:1114937620
Name:ASTHMA & ALLERGY CENTER OF THE NORTHERN SHENANDOAH VALLEY, INC.
Entity Type:Organization
Organization Name:ASTHMA & ALLERGY CENTER OF THE NORTHERN SHENANDOAH VALLEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CLARKSON
Authorized Official - Last Name:MCQUEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-662-9115
Mailing Address - Street 1:1828 W PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6365
Mailing Address - Country:US
Mailing Address - Phone:540-662-9115
Mailing Address - Fax:540-665-0411
Practice Address - Street 1:1828 W PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-662-9115
Practice Address - Fax:540-665-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA250242OtherCARELINK
WV001709030OtherMOUNTAIN STATE BCBS
VA06065OtherANTHEM BCBS
VA001709029OtherMOUNTAIN STATE BCBS
VA104849OtherOPTIMA/SENTARA
VA2119340ML2OtherMAMSI
WV3810005000Medicaid
VA39248OtherVIRGINIA PREMIER
WV3810005000Medicaid
VADB2625Medicare PIN
VA39248OtherVIRGINIA PREMIER
WV9372281Medicare PIN