Provider Demographics
NPI:1942603147
Name:JDG MEDICINE
Entity Type:Organization
Organization Name:JDG MEDICINE
Other - Org Name:CENTER FOR COMPREHENSIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JIM-DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-793-3644
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:757-321-8160
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101048671OtherLICENSE
VA1487629796OtherNPI
VABG3405455OtherDEA
VAVAA101113Medicare PIN