Healthcare Provider Details

I. General information

NPI: 1679574321
Provider Name (Legal Business Name): JOHN MICHAEL SYPTAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 RESERVOIR ST
HARRISONBURG VA
22801-8743
US

IV. Provider business mailing address

1831 RESERVOIR ST
HARRISONBURG VA
22801-8743
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-9151
  • Fax: 540-433-0547
Mailing address:
  • Phone: 540-433-9151
  • Fax: 540-433-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101052986
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: