Provider Demographics
NPI:1093704454
Name:PELLICANE, JAMES V JR (MD, FACS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:V
Last Name:PELLICANE
Suffix:JR
Gender:M
Credentials:MD, FACS
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:14051 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 2210
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3201
Mailing Address - Country:US
Mailing Address - Phone:804-594-3130
Mailing Address - Fax:804-594-3030
Practice Address - Street 1:14051 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 2210
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3201
Practice Address - Country:US
Practice Address - Phone:804-594-3130
Practice Address - Fax:804-594-3030
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101045452208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN
VAC09633OtherGROUP PTAN