MEDICARE: DR. JIM-DAVID GAGLIONE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0101048671	VA

General Provider Information

NPI Number	:	1487629796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIM-DAVID GAGLIONE MD

Provider Business Mailing Address
First Line	:	397 LITTLE NECK RD
Second Line	:	3300 SOUTH BUILDING, SUITE 314
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5765
Country	:	US
Telephone Number	:	757-773-2668
Fax Number	:	757-299-4141

Provider Business Practice Location Address
First Line	:	397 LITTLE NECK RD
Second Line	:	3300 SOUTH BUILDING, SUITE 314
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-5765
Country	:	US
Telephone Number	:	757-773-2668
Fax Number	:	757-299-4141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	10/01/2014

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