Provider Demographics
NPI:1003885245
Name:DREYZEHNER, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:DREYZEHNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:J
Other - Last Name:DREYZEHNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:22622 RED WOLF DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24211-5593
Mailing Address - Country:US
Mailing Address - Phone:276-889-7621
Mailing Address - Fax:276-889-7695
Practice Address - Street 1:155 ROGERS ST
Practice Address - Street 2:BOX 2347
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-4501
Practice Address - Country:US
Practice Address - Phone:276-889-7621
Practice Address - Fax:276-889-7695
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975085Medicaid
VA00V571R09Medicare PIN
VAH56034Medicare UPIN
VAC08813Medicare PIN
VA00V578D13Medicare PIN
VA004975085Medicaid
VA00V579T14Medicare PIN
VAC08814Medicare PIN