Provider Demographics
NPI:1417920984
Name:LITTON, JOHN SCOTT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SCOTT
Last Name:LITTON
Suffix:JR
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 646
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-0646
Mailing Address - Country:US
Mailing Address - Phone:276-546-4894
Mailing Address - Fax:276-546-4896
Practice Address - Street 1:1800 COMBS RD
Practice Address - Street 2:SUITE 7
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277-1808
Practice Address - Country:US
Practice Address - Phone:276-546-4894
Practice Address - Fax:276-546-4896
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010003539Medicaid
KY64067119Medicaid
KY64067119Medicaid
VAH48030Medicare UPIN
VA00V570L08Medicare PIN