Provider Demographics
NPI:1740253251
Name:LIGUSH, JOHN JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LIGUSH
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-654-7752
Practice Address - Street 1:595 MARTHA JEFFERSON DR STE 270
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4669
Practice Address - Country:US
Practice Address - Phone:434-654-1700
Practice Address - Fax:844-828-0597
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012338622083P0011X, 208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVN378AMedicare PIN
VAF82875Medicare UPIN
VA000567C10Medicare PIN
VA770003226OtherRAILROAD MEDICARE