Provider Demographics
NPI:1952388878
Name:JOHN, CHRISTOPHER KENYON (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:KENYON
Last Name:JOHN
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 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235961207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952388878OtherVA PREMIER
VA1952388878OtherAETNA
VA1952388878Medicaid
VA1952388878OtherGATEWAY
VA1952388878OtherANTHEM
VA1952388878OtherHEALTHKEEPERS
VA1952388878OtherCIGNA
VA1952388878OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1952388878OtherOPTIMA HEALTH PLAN
VA1952388878OtherVIRGINIA HEALTH NETWORK
VA1952388878OtherINTOTAL
VA1952388878OtherUMWA
VAP00834684OtherRAILROAD MEDICARE
VA1952388878OtherUNITED HEALTHCARE
VA1952388878OtherHEALTHKEEPERS PLUS
VA540506332115OtherTRICARE/CHAMPUS
VA1952388878OtherHUMANA MEDICARE
VA371194700OtherBLACK LUNG
VA3810018731OtherMEDICAID OF WEST VIRGINIA
VA1952388878OtherGATEWAY
VA1952388878Medicaid
VA1952388878Medicaid