Provider Demographics
NPI:1659489474
Name:GIBSON-NEALE, JANICE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:LYNN
Last Name:GIBSON-NEALE
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 1:101 COWARDIN AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-2078
Mailing Address - Country:US
Mailing Address - Phone:804-231-9691
Mailing Address - Fax:804-231-2241
Practice Address - Street 1:101 COWARDIN AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-2078
Practice Address - Country:US
Practice Address - Phone:804-231-9691
Practice Address - Fax:804-231-2241
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA044783OtherANTHEM BC/BS ID#
VA537948OtherAETNA PROVIDER #
VA006296513Medicaid
VA160024059QOtherRAILROAD MEDICARE ID#
VA541467765OtherTAX ID #
VA40188OtherVIRGINIA PREMIER ID#
VA48288OtherOPTIMA SENTARA ID #
VA006296513Medicaid
VA160024059QOtherRAILROAD MEDICARE ID#