Provider Demographics
NPI:1982681151
Name:AVILAHASKELL, VIRGINIA M (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:M
Last Name:AVILAHASKELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA VIRGINIA
Other - Middle Name:
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 73889
Mailing Address - Street 2:DEPT OF FM
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-3889
Mailing Address - Country:US
Mailing Address - Phone:310-908-8828
Mailing Address - Fax:
Practice Address - Street 1:1408 19TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5903
Practice Address - Country:US
Practice Address - Phone:310-908-8828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89929207Q00000X, 208D00000X
AK6825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice