Healthcare Provider Details

I. General information

NPI: 1649741729
Provider Name (Legal Business Name): GERALD EKOME ABOLLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date: 05/21/2019
Reactivation Date: 06/10/2026

III. Provider practice location address

109 BRIDGE ST APT 201
DANVILLE VA
24541-1246
US

IV. Provider business mailing address

109 BRIDGE ST APT 201
DANVILLE VA
24541-1246
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-4488
  • Fax: 434-773-6977
Mailing address:
  • Phone: 434-799-4488
  • Fax: 434-773-6977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0116041774
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: