=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366458283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES MARC CARDELIA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 01/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 171 KEMPSVILLE RD BUILDING A
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23502-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-668-6550
-----------------------------------------------------
Fax | 757-668-6544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 741593
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-1593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-668-8544
-----------------------------------------------------
Fax | 757-668-6544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XP3100X
-----------------------------------------------------
Taxonomy Name | Pediatric Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 0101229130
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------