Provider Demographics
NPI:1649248071
Name:D'AMELIO, JOHN P (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:D'AMELIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:P
Other - Last Name:D'AMELIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:3720 HOLLAND RD
Mailing Address - Street 2:STE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2859
Mailing Address - Country:US
Mailing Address - Phone:757-498-0202
Mailing Address - Fax:757-498-7936
Practice Address - Street 1:3720 HOLLAND RD
Practice Address - Street 2:STE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2859
Practice Address - Country:US
Practice Address - Phone:757-498-0202
Practice Address - Fax:757-498-7936
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000437213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5180770001OtherDMERC
VA5180770002OtherDMERC
VA9301518Medicaid
VA15803OtherOPTIMA HEALTH
VA216383OtherMDIPA
VA480021563OtherRR MCR
VA005906OtherANTHEM BLUE CROSS BLUE SH
VA480021563OtherRR MCR
VAU06326Medicare UPIN