Provider Demographics
NPI:1760466684
Name:HIRATA, ALICE J (MD)
Entity type:Individual
Prefix:MRS
First Name:ALICE
Middle Name:J
Last Name:HIRATA
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7130 GLEN FOREST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3754
Mailing Address - Country:US
Mailing Address - Phone:804-288-4084
Mailing Address - Fax:804-282-8678
Practice Address - Street 1:5875 BREMO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1934
Practice Address - Country:US
Practice Address - Phone:804-288-4084
Practice Address - Fax:804-282-2601
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2015-02-10
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Provider Licenses
StateLicense IDTaxonomies
VA0101044582207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760466684Medicaid
VAE86241Medicare UPIN
VA1760466684Medicaid