Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 0101040397 | VA |
N | 207ND0900X | Dermatopathologist | 0101040397 | VA |
N | 207NP0225X | Pediatric Dermatologist | 0101040397 | VA |
N | 207NS0135X | Procedural Dermatology | 0101040397 | VA |
NPI | 1295899953 |
---|---|
Provider Name | Dr. Alan Ellis Rolfe |
First Address | Norfolk, VA 23508-1227 |
Second Address | Norfolk, VA 23507-1901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 06/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0126246P05 | MEDICARE PTAN (01) | VA |
1295899953 | (05) | VA |