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NPI Code Detail

MEDICARE: JOHN FANTON MD

MEDICARE: JOHN FANTON MD
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 Physician0101278281VA

General Provider Information

NPI Number : 1881783397
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN FANTON MD
Provider Business Mailing Address
First Line : 601 CHILDRENS LN
Second Line :
City : NORFOLK
State : VA
Zip : 23507-1971
Country : US
Telephone Number : 757-668-5784
Fax Number :
Provider Business Practice Location Address
First Line : 601 CHILDRENS LN
Second Line :
City : NORFOLK
State : VA
Zip : 23507-1971
Country : US
Telephone Number : 757-668-5784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2006
Last Update Date : 09/26/2024

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