Provider Demographics
NPI:1215058870
Name:BITTNER, JAMES GRAHAM IV (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GRAHAM
Last Name:BITTNER
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:G
Other - Last Name:BITTNER
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2790 GODWIN BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8158
Mailing Address - Country:US
Mailing Address - Phone:757-934-4222
Mailing Address - Fax:757-934-4111
Practice Address - Street 1:2790 GODWIN BLVD STE 305
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8158
Practice Address - Country:US
Practice Address - Phone:757-934-4222
Practice Address - Fax:757-934-4111
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252146208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery