Provider Demographics
NPI:1487602330
Name:SACCOMANDO, JAMES G JR (MD, PC)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:G
Last Name:SACCOMANDO
Suffix:JR
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 N POTSDAM AVE # 61
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-7048
Mailing Address - Country:US
Mailing Address - Phone:208-866-8330
Mailing Address - Fax:208-213-1542
Practice Address - Street 1:401 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507
Practice Address - Country:US
Practice Address - Phone:757-668-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM95652084P0800X, 2084P0804X
PAMD4780822084P0800X
WA613138542084P0800X, 2084P0804X
VA01012808752084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500664707Medicaid
ID807512200Medicaid