Provider Demographics
NPI:1487629796
Name:GAGLIONE, JIM-DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JIM-DAVID
Middle Name:
Last Name:GAGLIONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 LITTLE NECK RD
Mailing Address - Street 2:3300 SOUTH BUILDING, SUITE 314
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-5765
Mailing Address - Country:US
Mailing Address - Phone:757-773-2668
Mailing Address - Fax:757-299-4141
Practice Address - Street 1:397 LITTLE NECK RD
Practice Address - Street 2:3300 SOUTH BUILDING, SUITE 314
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-5765
Practice Address - Country:US
Practice Address - Phone:757-773-2668
Practice Address - Fax:757-299-4141
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101048671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF86218Medicare UPIN
VA014175B09Medicare PIN
VAP00432560Medicare PIN