Provider Demographics
NPI:1184641870
Name:ALVANZO, ANIKA ADERO HARDIE (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:ANIKA
Middle Name:ADERO HARDIE
Last Name:ALVANZO
Suffix:
Gender:F
Credentials:MD, MS
Other - Prefix:
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Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:INTERNAL MEDICINE/ GEN MED/PRIMARY CARE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-8360
Practice Address - Fax:804-828-4862
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101232327207R00000X
MDD67688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005882931Medicaid
VA001050M84Medicare ID - Type UnspecifiedC03684