Provider Demographics
NPI:1497851356
Name:BOHANNON, JOSEPHINE S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:S
Last Name:BOHANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-378-5010
Mailing Address - Fax:804-378-3264
Practice Address - Street 1:2306 ROBIOUS STATION CIRCLE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113
Practice Address - Country:US
Practice Address - Phone:804-378-3048
Practice Address - Fax:804-379-5167
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VAVA0101039186207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA098270OtherANTHEM BS
VA098270OtherANTHEM BS