Healthcare Provider Details

I. General information

NPI: 1417987934
Provider Name (Legal Business Name): JAMES D. BYRNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WEST BUNK STREET SUITE 6
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

20 WEST BUNK STREET SUITE 7 DISTRICT 19 COMMUNITY SERVICES BOARD
PETERSBURG VA
23803-3279
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8002
  • Fax: 804-862-8023
Mailing address:
  • Phone: 804-862-8054
  • Fax: 804-863-1669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101237171
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: