| Dalraida Clinic | |
|
4135 Atlanta Hwy Montgomery AL 36109-3022 | |
| (334) 647-1444 | |
| (334) 647-1404 |
| Full Name | Dalraida Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 4135 Atlanta Hwy, Montgomery, Alabama |
| Authorized Official Name and Position | Eugene Romano (OFFICE MANAGER) |
| Authorized Official Contact | 3342074466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dalraida Clinic 4135 Atlanta Hwy Montgomery AL 36109-3022 Ph: (334) 647-1444 | Dalraida Clinic 4135 Atlanta Hwy Montgomery AL 36109-3022 Ph: (334) 647-1444 |
| NPI Number | 1164910543 |
|---|---|
| Provider Enumeration Date | 05/01/2018 |
| Last Update Date | 05/01/2018 |
| Medicare PECOS PAC ID | 8527318351 |
|---|---|
| Medicare Enrollment ID | O20180829000777 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164910543 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 2018 (Alabama) | Primary |
| Provider Name | Richard Gebhardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013434695 PECOS PAC ID: 6406118785 Enrollment ID: I20180327000002 |
| Provider Name | Tammie R Washington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811468945 PECOS PAC ID: 5799027033 Enrollment ID: I20190507000658 |
| Provider Name | Dhwani S Chotalia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669963617 PECOS PAC ID: 9234460809 Enrollment ID: I20191011002117 |
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