Provider Demographics
NPI:1518915206
Name:YON, DANDRIDGE H JR (PA)
Entity Type:Individual
Prefix:
First Name:DANDRIDGE
Middle Name:H
Last Name:YON
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 CLEVELAND STREET
Mailing Address - Street 2:SUITE 228
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1752
Mailing Address - Country:US
Mailing Address - Phone:757-499-2825
Mailing Address - Fax:757-499-4248
Practice Address - Street 1:1708 OLD DONATION PKWY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3064
Practice Address - Country:US
Practice Address - Phone:757-395-5300
Practice Address - Fax:757-395-5322
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518915206OtherTRICARE
VA33027POtherOPTIMA/SENTARA
VA1518915206Medicaid
P29021Medicare UPIN
VA1518915206Medicaid
VA970000464Medicare PIN