NPIMap

Organization Active NPI

Old Dominion Anesthesia LLC

  • Anesthesiology Physician
  • Charlottesville, VA
National Provider Identifier
1902248677
Registry record updated Jun 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
OLD DOMINION ANESTHESIA LLC
Practice address
1139 E High St Ste 203
Charlottesville, VA 22902-4849
Phone
(434) 817-8484
Fax
(434) 817-8490
NPI assigned
Jul 23, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alan Oliver
Title
Ceo
Phone
(786) 530-3820

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

1139 E High St Ste 203
Charlottesville, VA 22902-4849

Mailing address

PO Box 71819
Philadelphia, PA 19176-1819

Other practice location 1

3914 Centreville Rd
Ste 350
Chantilly, VA 20151-3289
Phone (703) 716-1097

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230316001226 VA Part B Supplier - Clinic/Group Practice 8820462765 Receives reassigned benefits from 88 practitioners
Practice locations: Charlottesville, VA; Manassas, VA; Woodbridge, VA
O20240227002876 DC Part B Supplier - Clinic/Group Practice 8820462765 Receives reassigned benefits from 89 practitioners
Practice locations: Chantilly, VA; Reston, VA; Alexandria, VA

National Provider Directory

National Provider Directory

Locations

1139 E High St
Ste 105
Charlottesvle, VA 22902
Phone (434) 817-8484

1939 Roland Clarke Pl
Ste 200
Reston, VA 20191
Phone (703) 435-3366

Practitioners & affiliated clinicians

Practitioners 270

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 270

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1374537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780617600000",
    "number": "1902248677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 71819",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191761819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1139 E HIGH ST STE 203",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229024849",
            "telephone_number": "434-817-8484",
            "fax_number": "434-817-8490"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3914 Centreville Rd",
            "address_2": "Ste 350",
            "address_purpose": "LOCATION",
            "city": "Chantilly",
            "state": "VA",
            "postal_code": "201513289",
            "country_code": "US",
            "telephone_number": "703-716-1097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OLD DOMINION ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-23",
        "last_updated": "2026-06-05",
        "certification_date": "2026-06-05",
        "status": "A",
        "authorized_official_last_name": "OLIVER",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "786-530-3820"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.