Provider Demographics
NPI:1013259563
Name:ALFREDO S. SISON JR MD LLC
Entity Type:Organization
Organization Name:ALFREDO S. SISON JR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:S
Authorized Official - Last Name:SISON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-379-2000
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058391174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA118318OtherBCBS
G83949OtherUPIN
VA007114982Medicaid
VA118318OtherBCBS