Provider Demographics
NPI:1558341578
Name:HENDRIX, JOHN D JR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:HENDRIX
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 826696
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-6696
Mailing Address - Country:US
Mailing Address - Phone:434-979-7700
Mailing Address - Fax:434-979-7700
Practice Address - Street 1:902 E JEFFERSON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5397
Practice Address - Country:US
Practice Address - Phone:434-979-7700
Practice Address - Fax:434-979-7715
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2020-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101045705207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA070015260Medicare PIN
VASC0001071Medicare PIN
F18583Medicare UPIN