Provider Demographics
NPI:1346342565
Name:GABLE, JAMES TICKNOR (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:TICKNOR
Last Name:GABLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:T
Other - Last Name:GABLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4407
Mailing Address - Country:US
Mailing Address - Phone:703-777-3262
Mailing Address - Fax:703-777-3365
Practice Address - Street 1:224 D CORNWALL STREET NW
Practice Address - Street 2:SUITE 204
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4407
Practice Address - Country:US
Practice Address - Phone:703-777-3262
Practice Address - Fax:703-777-3365
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102021182207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6459269Medicaid
VA202930183Medicare PIN
B09526Medicare UPIN