Provider Demographics
NPI:1942741723
Name:VANCE, JOHN EDWARD (BOCO, ATC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:VANCE
Suffix:
Gender:M
Credentials:BOCO, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WRNMMC ORTHOTICS & PROSTHETICS
Mailing Address - Street 2:8901 WISCONSIN AVENUE, BLDG 19, FL 1ST, RM 1500
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:WRNMMC ORTHOTICS & PROSTHETICS
Practice Address - Street 2:8901 WISCONSIN AVENUE, BLDG 19, FL 1ST, RM 1500
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889
Practice Address - Country:US
Practice Address - Phone:301-221-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC50185222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist