Healthcare Provider Details

I. General information

NPI: 1992812002
Provider Name (Legal Business Name): JOHN L TROTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN LOUIS TROTTER

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/07/2023
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 HAMILTON BLVD
SOUTH BOSTON VA
24592-5200
US

IV. Provider business mailing address

422 HAMILTON BLVD
SOUTH BOSTON VA
24592-5200
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-4074
  • Fax:
Mailing address:
  • Phone: 434-572-4074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number29684
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101274909
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: