Provider Demographics
NPI:1841369402
Name:EHRENFRIED, JOHN ALBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBERT
Last Name:EHRENFRIED
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 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:130 W RAVINE RD STE 3A
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3841
Practice Address - Country:US
Practice Address - Phone:423-245-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD34462208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007311095Medicaid
TN3046047Medicaid
TN3151526OtherBLUE CROSS TENNESSEE
VA382329OtherANTHEM VIRGINIA BCBS
TN910000313OtherMEDICARE RAILROAD
VA007311095Medicaid
TN3046047Medicaid
TN103I028451Medicare PIN