Healthcare Provider Details

I. General information

NPI: 1669581500
Provider Name (Legal Business Name): JOHN R LENNON IV P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 BATTLEFIELD BLVD S STE 100
CHESAPEAKE VA
23322-4215
US

IV. Provider business mailing address

667 KINGSBOROUGH SQ STE 101
CHESAPEAKE VA
23320-4999
US

V. Phone/Fax

Practice location:
  • Phone: 757-312-2299
  • Fax: 757-312-2256
Mailing address:
  • Phone: 757-842-4481
  • Fax: 757-312-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-08694
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002100
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: