Provider Demographics
NPI:1205804754
Name:CARGO, JON D (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:D
Last Name:CARGO
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 1:1900 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7474
Mailing Address - Country:US
Mailing Address - Phone:540-776-4000
Mailing Address - Fax:540-776-2083
Practice Address - Street 1:1900 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:540-776-4000
Practice Address - Fax:540-776-2083
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-231473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010253004Medicaid
VA010254370Medicaid
VA1205804754Medicaid
VA010254370Medicaid
VA010253004Medicaid
F19691Medicare UPIN
VAVAA103616Medicare PIN
010041C22Medicare PIN
VA017982C18Medicare PIN