Provider Demographics
NPI:1942487970
Name:JOHN, JUSTIN MATHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:MATHEW
Last Name:JOHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1112 LADY GINGER LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5657
Mailing Address - Country:US
Mailing Address - Phone:757-305-9929
Mailing Address - Fax:757-668-9735
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7320
Practice Address - Fax:757-668-9735
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-10-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101243343207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology