Provider Demographics
NPI:1366458283
Name:CARDELIA, JAMES MARC (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARC
Last Name:CARDELIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 741593
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1593
Mailing Address - Country:US
Mailing Address - Phone:757-668-8544
Mailing Address - Fax:757-668-6544
Practice Address - Street 1:171 KEMPSVILLE RD
Practice Address - Street 2:BUILDING A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4700
Practice Address - Country:US
Practice Address - Phone:757-668-6550
Practice Address - Fax:757-668-6544
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101229130207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006712991OtherVA PREMIER
VA283177OtherALLIANCE/MDIPA
VA4397279OtherAETNA
VAG47212OtherBEECH STREET
VA006712991Medicaid
VA89063PGOtherNORTH CAROLINA MEDICAID
VA29771OtherOPTIMA/SENTARA HEALTH
VA311610834OtherNC HEALTH CHOICE
VA283177OtherMAMSI/OPTIMUM CHOICE
VA3116108340005EOtherCIGNA
VA452226OtherANTHEM BCBS
VA3116108340005EOtherCIGNA
VA006712991Medicaid