Provider Demographics
NPI:1912986860
Name:EDDY, JANET (MD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:EDDY
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 1:8000 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1306
Mailing Address - Country:US
Mailing Address - Phone:804-612-7065
Mailing Address - Fax:804-612-7066
Practice Address - Street 1:8000 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1306
Practice Address - Country:US
Practice Address - Phone:804-612-7065
Practice Address - Fax:804-612-7066
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042501207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005638968Medicaid
VAC09633OtherGROUP PTAN
VAC09633OtherGROUP PTAN
E57223Medicare UPIN