Healthcare Provider Details

I. General information

NPI: 1972166387
Provider Name (Legal Business Name): JOHN PATRICK LAURENZANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2019
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 LOFTIS BLVD
NEWPORT NEWS VA
23606-2981
US

IV. Provider business mailing address

1031 LOFTIS BLVD
NEWPORT NEWS VA
23606-2981
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-9850
  • Fax:
Mailing address:
  • Phone: 757-736-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101285069
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101285069
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: