Provider Demographics
NPI:1922270362
Name:JAVERNICK, MICHAEL J I (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:JAVERNICK
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:477 MCLAWS CIR
Mailing Address - Street 2:STE 1
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6316
Mailing Address - Country:US
Mailing Address - Phone:757-208-0005
Mailing Address - Fax:757-208-0006
Practice Address - Street 1:477 MCLAWS CIR
Practice Address - Street 2:STE 1
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6316
Practice Address - Country:US
Practice Address - Phone:757-208-0005
Practice Address - Fax:757-208-0006
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2013-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101242377207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1922270362OtherMEDICARE