=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669581500
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN R LENNON IV P.A.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1034 BATTLEFIELD BLVD S STE 100
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23322-4215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-312-2299
-----------------------------------------------------
Fax | 757-312-2256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 667 KINGSBOROUGH SQ STE 101
-----------------------------------------------------
City | CHESAPEAKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23320-4999
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-842-4481
-----------------------------------------------------
Fax | 757-312-3135
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0010-08694
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 0110002100
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------