Individual
JOHN M OLSSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1204 W MAIN ST FL 6, CHARLOTTESVILLE, VA 22908-4300
(434) 924-5321
(434) 924-5352
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101263142
VA
208000000X
Pediatrics Physician
9801733
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1163A
BCBS NC
NC
05
—
1194710632
—
NC
01
—
2262361B
MEDICARE
NC
01
—
990014475
RAILROAD MEDICARE
NC
Enumeration date
09/12/2005
Last updated
11/09/2017
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