Healthcare Provider Details

I. General information

NPI: 1538141338
Provider Name (Legal Business Name): J H HERSHEY M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 11/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 PEPPER ST S SUITE A
CHRISTIANSBURG VA
24073-3522
US

IV. Provider business mailing address

PO BOX 2080
KILMARNOCK VA
22482-2080
US

V. Phone/Fax

Practice location:
  • Phone: 540-381-7100
  • Fax: 540-381-7108
Mailing address:
  • Phone: 804-435-3508
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101-035870
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: