Healthcare Provider Details

I. General information

NPI: 1588689251
Provider Name (Legal Business Name): JOHN R. SWEENEY, JR., M.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2453 PRUDEN BLVD
SUFFOLK VA
23434-4235
US

IV. Provider business mailing address

PO BOX 631982
BALTIMORE MD
21263-1982
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-7771
  • Fax: 757-539-4360
Mailing address:
  • Phone: 757-668-7200
  • Fax: 757-668-9691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN R. SWEENEY JR.
Title or Position: OWNER
Credential: M.D.
Phone: 757-539-7771