Healthcare Provider Details

I. General information

NPI: 1972768109
Provider Name (Legal Business Name): JOHN S. MANCOLL, MD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/21/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 FISHER ARCH
VIRGINIA BEACH VA
23456
US

IV. Provider business mailing address

2017 FISHER ARCH
VIRGINIA BEACH VA
23456
US

V. Phone/Fax

Practice location:
  • Phone: 757-305-9185
  • Fax: 757-305-9186
Mailing address:
  • Phone: 757-305-9185
  • Fax: 757-305-9186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN S MANCOLL
Title or Position: PRESIDENT
Credential: MD
Phone: 757-305-9185