1346342565 NPI number — DR. JAMES TICKNOR GABLE DO

Table of content: DR. JAMES TICKNOR GABLE DO (NPI 1346342565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346342565 NPI number — DR. JAMES TICKNOR GABLE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GABLE
Provider First Name:
JAMES
Provider Middle Name:
TICKNOR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GABLE
Provider Other First Name:
JAMES
Provider Other Middle Name:
T
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346342565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 D CORNWALL STREET NW
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20176-4407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-777-3262
Provider Business Mailing Address Fax Number:
703-777-3365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
224 D CORNWALL STREET NW
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-4407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-777-3262
Provider Business Practice Location Address Fax Number:
703-777-3365
Provider Enumeration Date:
09/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  0102021182 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6459269 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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