Provider Demographics
NPI:1558392381
Name:ACREE, JOHN THOMAS (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:ACREE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 SOUTH RALEIGH ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-2640
Mailing Address - Country:US
Mailing Address - Phone:304-264-9525
Mailing Address - Fax:304-264-9524
Practice Address - Street 1:411 SOUTH RALEIGH ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-2640
Practice Address - Country:US
Practice Address - Phone:304-264-9525
Practice Address - Fax:304-264-9524
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00317213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001722106OtherBCBS
WV0100045000Medicaid
WV0842821Medicare PIN
WV0100045000Medicaid
WVU49256Medicare UPIN