Provider Demographics
NPI:1053428862
Name:ACCETTOLA, ROBERT J (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:ACCETTOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-2405
Mailing Address - Country:US
Mailing Address - Phone:757-686-9400
Mailing Address - Fax:757-686-9449
Practice Address - Street 1:3737 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-2405
Practice Address - Country:US
Practice Address - Phone:757-686-9400
Practice Address - Fax:757-686-9449
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039484207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO10109060Medicaid
VAB78084Medicare UPIN
VAO10109060Medicaid
VAC08903Medicare ID - Type Unspecified