Healthcare Provider Details

I. General information

NPI: 1699776880
Provider Name (Legal Business Name): JAMES R ABBOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

238 BROOKLEY AVE
BOLLING AFB DC
20332-0001
US

IV. Provider business mailing address

5201 LEESBURG PIKE SUITE 1511
FALLS CHURCH VA
22041-3203
US

V. Phone/Fax

Practice location:
  • Phone: 202-404-5512
  • Fax:
Mailing address:
  • Phone: 703-681-6078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: