Individual
JOHN F DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
(540) 983-1022
Mailing address
1970 ROANOKE BLVD, SALEM, VA 24153-6404
(540) 982-2463
(540) 983-1022
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
16510
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0073762000
—
WV
05
—
2388250
—
OH
05
—
64071384
—
KY
01
—
P00002536
RAILROAD MEDICARE
—
Enumeration date
06/09/2006
Last updated
05/27/2011
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