Healthcare Provider Details

I. General information

NPI: 1790782092
Provider Name (Legal Business Name): JAMES RUSSELL HENGERER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2321 ATHERHOLT RD SUITE B
LYNCHBURG VA
24501-2113
US

IV. Provider business mailing address

2849 LINK RD
LYNCHBURG VA
24503-3217
US

V. Phone/Fax

Practice location:
  • Phone: 434-947-3993
  • Fax: 434-847-2941
Mailing address:
  • Phone: 434-384-8745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0101032236
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: