Provider Demographics
NPI:1912056771
Name:GERVIN, ALFRED SPENCER (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:SPENCER
Last Name:GERVIN
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROADS END LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-6109
Mailing Address - Country:US
Mailing Address - Phone:804-784-9012
Mailing Address - Fax:804-784-9016
Practice Address - Street 1:9702 GAYTON RD # 327
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4907
Practice Address - Country:US
Practice Address - Phone:804-784-9012
Practice Address - Fax:804-784-9016
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA36192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist