Healthcare Provider Details

I. General information

NPI: 1871533992
Provider Name (Legal Business Name): JOHN THOMAS JANOUSEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/25/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 MDG NEELEY AVE
HAMPTON VA
23665
US

IV. Provider business mailing address

401 BLEVINS RUN
YORKTOWN VA
23693-4185
US

V. Phone/Fax

Practice location:
  • Phone: 757-764-6800
  • Fax:
Mailing address:
  • Phone: 757-532-1686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME88851
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101052906
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2001-00052
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: