MEDICARE: DR. JOHN VINCENT BOOTH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	0101233970	VA

General Provider Information

NPI Number	:	1528064292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN VINCENT BOOTH M.D.

Provider Business Mailing Address
First Line	:	9101 STONY POINT DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1979
Country	:	US
Telephone Number	:	804-330-9105
Fax Number	:

Provider Business Practice Location Address
First Line	:	9101 STONY POINT DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1979
Country	:	US
Telephone Number	:	804-330-9105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	10/28/2020

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