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Individual

DR. JANICE LYNN GIBSON-NEALE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
101 COWARDIN AVE, SUITE 208, RICHMOND, VA 23224-2078
(804) 231-9691
(804) 231-2241
Mailing address
101 COWARDIN AVE, SUITE 208, RICHMOND, VA 23224-2078
(804) 231-9691
(804) 231-2241

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
0101040790
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
006296513
VA
01
044783
ANTHEM BC/BS ID#
VA
01
160024059Q
RAILROAD MEDICARE ID#
VA
01
40188
VIRGINIA PREMIER ID#
VA
01
48288
OPTIMA SENTARA ID #
VA
01
537948
AETNA PROVIDER #
VA
01
541467765
TAX ID #
VA
Enumeration date
08/29/2006
Last updated
02/11/2022
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