Provider Demographics
NPI:1235169236
Name:ABBOTT, JAMES E (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:ABBOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-6605
Mailing Address - Country:US
Mailing Address - Phone:804-359-4093
Mailing Address - Fax:804-359-8961
Practice Address - Street 1:1101 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-6605
Practice Address - Country:US
Practice Address - Phone:804-359-4093
Practice Address - Fax:804-359-8961
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010419981Medicaid
VA4063207OtherAETNA LIFE
VA005614791Medicaid
VA084988OtherANTHEM BCBS OF VA
VA227362OtherMAMSI
VA57269OtherSOUTHERN HEALTH SERVICES
VA080066840OtherRAILROAD MEDICARE
VA1439767OtherCIGNA
VA43446OtherSENTARA
VA4063207OtherAETNA HMO
VA010419981Medicaid
VA43446OtherSENTARA
080004466Medicare ID - Type Unspecified
VAB10012Medicare UPIN