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NPI Code Detail

MEDICARE: DR. JOHN L. HENDRICKSON M.D.

MEDICARE: DR. JOHN L. HENDRICKSON M.D.
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
12084P0804XChild & Adolescent Psychiatry Physician0101053066VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1O87204OTHERSENTARA/OPTIMA PROVIDER N
2186463OTHERANTHEM PROVIDER NUMBER
3203639329001OTHERTRICARE PROVIDER NUMBER
42016147OTHERCIGNA BEHAVIOR PROVIDER N
5132551OTHERVALUE OPTIONS PROVIDER NU

General Provider Information

NPI Number : 1699775593
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN L. HENDRICKSON M.D.
Provider Business Mailing Address
First Line : 1204 FENWICK DR
Second Line :
City : LYNCHBURG
State : VA
Zip : 24502-2112
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3300 RIVERMONT AVE
Second Line :
City : LYNCHBURG
State : VA
Zip : 24503-2030
Country : US
Telephone Number : 434-200-5999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 03/12/2008

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