Provider Demographics
NPI:1811005838
Name:SISON, ALFREDO S JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:S
Last Name:SISON
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2601 RADNOR PL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6496
Mailing Address - Country:US
Mailing Address - Phone:804-379-2000
Mailing Address - Fax:804-594-7203
Practice Address - Street 1:110 N ROBINSON ST STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4460
Practice Address - Country:US
Practice Address - Phone:804-379-2000
Practice Address - Fax:804-594-7203
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010583912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA118318OtherBCBS
VAG83949Medicare UPIN