Provider Demographics
NPI:1619902913
Name:PINKSTON, JOHN WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAYNE
Last Name:PINKSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 POPLAR FOREST CT
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-7584
Mailing Address - Country:US
Mailing Address - Phone:757-436-6835
Mailing Address - Fax:
Practice Address - Street 1:400 S WITCHDUCK RD
Practice Address - Street 2:SUITE 110
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3635
Practice Address - Country:US
Practice Address - Phone:757-671-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010458112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD57472Medicare UPIN