Provider Demographics
NPI:1407905318
Name:BIDDULPH, JOHN T (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:BIDDULPH
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:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22555-1750
Mailing Address - Country:US
Mailing Address - Phone:540-370-1600
Mailing Address - Fax:
Practice Address - Street 1:20 P G A DR STE 203
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8218
Practice Address - Country:US
Practice Address - Phone:540-370-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75845207X00000X
VA0101042704207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5748700OtherAETNA PROVIDER ID
VA6400345Medicaid
VA1201805OtherFIRST HEALTH PROVIDER ID
VA140440OtherANTHEM PROVIDER ID
VA5748700OtherAETNA PROVIDER ID
VA6400345Medicaid