Provider Demographics
NPI:1184033904
Name:OVIDE, ALLISON (PA)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:OVIDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:AMANDA
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 SHADY LN
Practice Address - Street 2:
Practice Address - City:WHITE STONE
Practice Address - State:VA
Practice Address - Zip Code:22578-2601
Practice Address - Country:US
Practice Address - Phone:804-435-3133
Practice Address - Fax:804-435-1311
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004641363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant