Provider Demographics
NPI:1275609745
Name:PALMINTIER, JON (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:PALMINTIER
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 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 308
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-288-7077
Mailing Address - Fax:804-285-8120
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 308
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-288-7077
Practice Address - Fax:804-285-8120
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037038208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CF1951OtherRAILROAD MEDICARE
B10137Medicare UPIN
C04410Medicare PIN