Provider Demographics
NPI:1538233648
Name:WALLER, ALENE HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:ALENE
Middle Name:HOWARD
Last Name:WALLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:128 SPECIAL PROGRAMS BUILDING
Mailing Address - Street 2:UNIVERSITY OF RICHMOND STUDENT HEALTH CENTER
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23173-0001
Mailing Address - Country:US
Mailing Address - Phone:804-289-8064
Mailing Address - Fax:804-287-6466
Practice Address - Street 1:128 SPECIAL PROGRAMS BUILDING
Practice Address - Street 2:UNIVERSITY OF RICHMOND STUDENT HEALTH CENTER
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23173-0001
Practice Address - Country:US
Practice Address - Phone:804-289-8064
Practice Address - Fax:804-287-6466
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101044642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE94108Medicare UPIN