MEDICARE: JOHN D. PAYNE, M.D. LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101028140	VA

General Provider Information

NPI Number	:	1124202239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D. PAYNE, M.D. LTD.

Provider Business Mailing Address
First Line	:	6458 MADISON CT
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-4137
Country	:	US
Telephone Number	:	703-821-1018
Fax Number	:	703-848-1755

Provider Business Practice Location Address
First Line	:	1314 MADISON CT.
Second Line	:
City	:	MCLEAN
State	:	VA
Zip	:	22101
Country	:	US
Telephone Number	:	703-821-1018
Fax Number	:	703-848-1755

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN D. PAYNE
Credential	:	M.D.
Telephone Number	:	703-821-1018

Provider Enumeration Date	:	12/26/2007
Last Update Date	:	12/26/2007

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