Provider Demographics
NPI:1811093495
Name:ROBERT J. ACCETTOLA, MD, LLC
Entity type:Organization
Organization Name:ROBERT J. ACCETTOLA, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRODICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:757-606-2012
Mailing Address - Street 1:3737 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-2405
Mailing Address - Country:US
Mailing Address - Phone:757-686-9400
Mailing Address - Fax:757-686-9449
Practice Address - Street 1:3737 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-2405
Practice Address - Country:US
Practice Address - Phone:757-686-9400
Practice Address - Fax:757-686-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039484207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO10109060Medicaid
VAB78084Medicare UPIN
VAO10109060Medicaid