Individual
AILENE D MEDALLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
725 VOLVO PKWY STE 100, CHESAPEAKE, VA 23320
(757) 548-0076
(757) 548-1652
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3508
(757) 686-0541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101264734
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/07/2015
Last updated
07/11/2018
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