Provider Demographics
NPI:1831184696
Name:OGRAM, JOHN DONALD (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DONALD
Last Name:OGRAM
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:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0993
Mailing Address - Country:US
Mailing Address - Phone:757-442-5445
Mailing Address - Fax:757-442-5540
Practice Address - Street 1:4376 LANKFORD HWY STE 3
Practice Address - Street 2:
Practice Address - City:EXMORE
Practice Address - State:VA
Practice Address - Zip Code:23350
Practice Address - Country:US
Practice Address - Phone:757-442-2504
Practice Address - Fax:757-442-9099
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010338542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB94869Medicare UPIN