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NPI Code Detail

MEDICARE: JOHN R LENNON IV P.A.

MEDICARE: JOHN R LENNON IV P.A.
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
1363A00000XPhysician Assistant0010-08694NC
2363A00000XPhysician Assistant0110002100VA

General Provider Information

NPI Number : 1669581500
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN R LENNON IV P.A.
Provider Business Mailing Address
First Line : 1301 EXECUTIVE BLVD STE 200
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23320-3671
Country : US
Telephone Number : 757-842-4481
Fax Number : 757-312-3135
Provider Business Practice Location Address
First Line : 1034 BATTLEFIELD BLVD S STE 100
Second Line :
City : CHESAPEAKE
State : VA
Zip : 23322-4215
Country : US
Telephone Number : 757-312-2299
Fax Number : 757-312-2256
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2006
Last Update Date : 02/05/2026

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