Provider Demographics
NPI:1932158649
Name:KENERSON, JOHN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:KENERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5700 CLEVELAND STREET
Mailing Address - Street 2:SUITE 228
Mailing Address - City:VIRGINA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1752
Mailing Address - Country:US
Mailing Address - Phone:757-499-2825
Mailing Address - Fax:757-499-2825
Practice Address - Street 1:1708 OLD DONATION PARKWAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3064
Practice Address - Country:US
Practice Address - Phone:757-395-5300
Practice Address - Fax:757-213-9341
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101034324207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA-001OtherTRICARE/CHAMPUS
VA332623OtherANTHEM BCBS
VAPAROtherCIGNA
VAPAROtherVIRGINIA HEALTH NETWORK
NC05912OtherBCBS
VA239706OtherANTHEM
VAPAROtherMULTIPLAN
428965OtherUHC/MAMSI
VAPAROtherAETNA
VA1932158649Medicaid
VA006016359Medicaid
VA10011413OtherSHP OHP
VAPAROtherVIRGINIA PREMIER HEALTH
NC8905912Medicaid
VA15573OtherOPTIMA/SENTARA
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORCARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA10011413OtherSHP OHP
VAPAROtherVIRGINIA PREMIER HEALTH
NC8905912Medicaid
VA012619C92Medicare PIN