Accomack County, Virginia is located in the Eastern Shore Health District. It has 449.3 square miles of land area and is the 36th largest county in Virginia by total area. It is bordered by Northumberland, Northampton, Mathews, Middlesex, and Lancaster County, Virginia and by Worcester, Maryland, Somerset, and Mathews County, Maryland. There are 12 census tracts in the county. The county FIPS number is 51001.

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