Provider Demographics
NPI:1275524118
Name:WESDOCK, JAMES CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:WESDOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13220 DRAKEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3887
Mailing Address - Country:US
Mailing Address - Phone:804-929-7045
Mailing Address - Fax:
Practice Address - Street 1:13911 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114
Practice Address - Country:US
Practice Address - Phone:804-320-3999
Practice Address - Fax:804-323-9383
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0000244692701OtherUNITED HEALTHCARE
VA146269OtherANTHEM BC
VA006194F47Medicare ID - Type Unspecified
VA146269OtherANTHEM BC