Healthcare Provider Details

I. General information

NPI: 1598927030
Provider Name (Legal Business Name): JAMES B CARMODY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: BRYAN CARMODY MD

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7244
  • Fax: 757-668-9814
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101249719
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number0101249719
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: