Provider Demographics
NPI:1871559070
Name:HENNESSEY, JOHN JOSEPH IV (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:HENNESSEY
Suffix:IV
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 1:1401 JOHNSTON WILLIS DR
Mailing Address - Street 2:THE ATRIUM SUITE 5300
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-323-1145
Mailing Address - Fax:804-272-1903
Practice Address - Street 1:1401 JOHNSTON WILLIS DR
Practice Address - Street 2:THE ATRIUM SUITE 5300
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-323-1145
Practice Address - Fax:804-272-1903
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA012879OtherBLUE CROSS BLUE SHIELD
VA006504OtherBLUE CROSS BLUE SHIELD GR
VA006195334Medicaid
VA220633OtherOPTIMUM CHOICE
VA006504OtherBLUE CROSS BLUE SHIELD GR
VAB05771Medicare UPIN
VA130000057Medicare ID - Type Unspecified