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General NPI Number Information
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NPI Number | 1942603147
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Entity Type | Organization
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Legal Business Name | JDG MEDICINE
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 397 LITTLE NECK RD 3300 SOUTH BUILDING, SUITE 314
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5765
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Country | US
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Telephone | 757-773-2668
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Fax | 757-299-4141
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Provider Business Mailing Address
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Address Line | 397 LITTLE NECK RD 3300 SOUTH BUILDING, SUITE 314
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-5765
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Country | US
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Telephone | 757-321-8160
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Fax | 757-299-4141
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JIM-DAVID GAGLIONE
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Credential | MD
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Telephone | 757-793-3644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101048671
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License Number State | VA
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