Provider Demographics
NPI:1558396184
Name:ALLEGHANY ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:ALLEGHANY ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARID
Authorized Official - Middle Name:
Authorized Official - Last Name:DAKERMANDJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-345-3556
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:ONE ARCH LANE
Practice Address - Street 2:
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457
Practice Address - Country:US
Practice Address - Phone:540-345-3556
Practice Address - Fax:540-342-2193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB59619207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA064642OtherANTHEM
VA145812OtherANTHEM
VA036788OtherANTHEM
VA036792OtherANTHEM
VA451751OtherANTHEM
VA431567OtherANTHEM
VA431570OtherANTHEM
VA145812OtherANTHEM
VA431567OtherANTHEM
VA064642OtherANTHEM
S17055Medicare UPIN
VAB59619Medicare UPIN
VAC02341Medicare PIN