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General NPI Number Information
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NPI Number | 1487602330
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Entity Type | Individual
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Provider Name | JAMES G SACCOMANDO JR. MD, PC
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 401 GRESHAM DR
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City | NORFOLK
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State | VA
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Zip | 23507
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Country | US
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Telephone | 757-668-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 3916 N POTSDAM AVE # 61
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City | SIOUX FALLS
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State | SD
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Zip | 57104-7048
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Country | US
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Telephone | 208-866-8330
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Fax | 208-213-1542
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M9565
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD478082
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 61313854
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | M9565
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 61313854
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 0101280875
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License Number State | VA
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