Healthcare Provider Details

I. General information

NPI: 1831184696
Provider Name (Legal Business Name): JOHN DONALD OGRAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4376 LANKFORD HWY STE 3
EXMORE VA
23350
US

IV. Provider business mailing address

PO BOX 993
NASSAWADOX VA
23413-0993
US

V. Phone/Fax

Practice location:
  • Phone: 757-442-2504
  • Fax: 757-442-9099
Mailing address:
  • Phone: 757-442-5445
  • Fax: 757-442-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101033854
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: