Provider Demographics
NPI:1518954239
Name:DEBORD, EMILY (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DEBORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 EAST VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210
Mailing Address - Country:US
Mailing Address - Phone:276-628-1106
Mailing Address - Fax:276-676-0215
Practice Address - Street 1:322 EAST VALLEY ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210
Practice Address - Country:US
Practice Address - Phone:276-628-1106
Practice Address - Fax:276-676-0215
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010072689Medicaid
VA010072689Medicaid