Provider Demographics
NPI:1871603431
Name:JOHN W. CARMODY, MD, PC
Entity type:Organization
Organization Name:JOHN W. CARMODY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CARMODY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-236-9393
Mailing Address - Street 1:502 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-3918
Mailing Address - Country:US
Mailing Address - Phone:276-236-9393
Mailing Address - Fax:276-236-2882
Practice Address - Street 1:502 S MAIN ST
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-3918
Practice Address - Country:US
Practice Address - Phone:276-236-9393
Practice Address - Fax:276-236-2882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233327207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982677415OtherDR. CARMODY NPI
VA386048OtherANTHEM
VA1073586186OtherMARK DAVIS, PA-C NPI
VAB19131Medicare UPIN
VA1073586186OtherMARK DAVIS, PA-C NPI
VA1982677415OtherDR. CARMODY NPI
VA4732100001Medicare NSC
VA00V6773J05Medicare PIN