Provider Demographics
NPI:1447299110
Name:MANSFIELD, JOHN BRISTOW (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRISTOW
Last Name:MANSFIELD
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 1:831 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3277
Mailing Address - Country:US
Mailing Address - Phone:540-434-8101
Mailing Address - Fax:540-574-2151
Practice Address - Street 1:831 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3277
Practice Address - Country:US
Practice Address - Phone:540-434-8101
Practice Address - Fax:540-574-2151
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030926208600000X
IA21481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007383088Medicaid
VA7383088Medicaid
VA005385OtherANTHEM, RICHMOND, VA
VA6251400001Medicare NSC
VA005385OtherANTHEM, RICHMOND, VA
B07920Medicare UPIN
VA007383088Medicaid