MEDICARE: DR. DIANE ABDO PSYD

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	103TC0700X	Clinical Psychologist	0810-001755	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538250931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE ABDO PSYD

Provider Business Mailing Address
First Line	:	1309 JAMESTOWN RD
Second Line	:	STE. 101
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3380
Country	:	US
Telephone Number	:	757-220-8800
Fax Number	:	757-220-8811

Provider Business Practice Location Address
First Line	:	1309 JAMESTOWN RD
Second Line	:	STE. 101
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-3380
Country	:	US
Telephone Number	:	757-220-8800
Fax Number	:	757-220-8811

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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