Provider Demographics
NPI:1770554982
Name:DELLA VECCHIA, JASON J (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:DELLA VECCHIA
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 1:5 GARDEN WAY
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6086
Mailing Address - Country:US
Mailing Address - Phone:423-483-7701
Mailing Address - Fax:423-431-1811
Practice Address - Street 1:1700 PINEBROOK DR STE 4
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4365
Practice Address - Country:US
Practice Address - Phone:423-251-6670
Practice Address - Fax:423-251-1899
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400663207R00000X
SC31318207R00000X
TN47972207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527494Medicaid
NC891362HMedicaid
KY7100194900Medicaid
NC1362HOtherBCBS
NCP00213994OtherRAILROAD MEDICARE
VA1770554982Medicaid
TN1527494Medicaid
KY7100194900Medicaid
NC1362HOtherBCBS