Provider Demographics
NPI:1487603205
Name:WADDY, JAMES MITCHELL JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MITCHELL
Last Name:WADDY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3920 A BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:757-983-2200
Mailing Address - Fax:757-275-9993
Practice Address - Street 1:3920 A BRIDGE RD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-983-2200
Practice Address - Fax:757-275-9993
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA101232080207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10048052Medicaid
VAH81152Medicare UPIN
VA10048052Medicaid