=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831184696
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN DONALD OGRAM M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/16/2005
-----------------------------------------------------
Last Update Date | 08/09/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4376 LANKFORD HWY STE 3
-----------------------------------------------------
City | EXMORE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-442-2504
-----------------------------------------------------
Fax | 757-442-9099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 993
-----------------------------------------------------
City | NASSAWADOX
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23413-0993
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-442-5445
-----------------------------------------------------
Fax | 757-442-5540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 0101033854
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------