Provider Demographics
NPI:1356315444
Name:VANCE, JOHN CLAIR (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CLAIR
Last Name:VANCE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11447 CRONHILL DR
Mailing Address - Street 2:STE D
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117
Mailing Address - Country:US
Mailing Address - Phone:443-544-2335
Mailing Address - Fax:410-581-7383
Practice Address - Street 1:1701 N GEORGE MANSON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205
Practice Address - Country:US
Practice Address - Phone:703-558-6730
Practice Address - Fax:703-558-5741
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010189202085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7200544Medicaid
VA7200544Medicaid
VA000N49V18Medicare ID - Type Unspecified