Provider Demographics
NPI:1598734162
Name:CARDWELL, JOHN (PA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CARDWELL
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2091 LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1428
Mailing Address - Country:US
Mailing Address - Phone:434-947-3954
Mailing Address - Fax:434-947-5944
Practice Address - Street 1:2410 ATHERHOLT RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2148
Practice Address - Country:US
Practice Address - Phone:434-200-5252
Practice Address - Fax:434-847-3645
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110001057363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016022C41Medicare PIN
VAS98426Medicare UPIN