Provider Demographics
NPI:1356332290
Name:VERHEUL, JOHN WILLEM (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLEM
Last Name:VERHEUL
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 1:1230 ALVERSER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2653
Mailing Address - Country:US
Mailing Address - Phone:804-893-7800
Mailing Address - Fax:804-893-7801
Practice Address - Street 1:1230 ALVERSER DR STE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2653
Practice Address - Country:US
Practice Address - Phone:804-423-9919
Practice Address - Fax:804-423-9917
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5640652Medicaid
VA051223OtherANTHEM BC
VA051223OtherANTHEM BC