Organization
ASSOCIATED NEUROLOGISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN JOSEPH HENNESSEY IV M.D. (PRESIDENT)
(804) 323-1145
Entity
Organization
Contact information
Practice address
1401 JOHNSTON WILLIS DR, THE ATRIUM SUITE 5300, RICHMOND, VA 23235-4730
(804) 323-1145
(804) 272-1903
Mailing address
1401 JOHNSTON WILLIS DR, THE ATRIUM SUITE 5300, RICHMOND, VA 23235-4730
(804) 323-1145
(804) 272-1903
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101031272
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006195334
—
VA
01
—
006504
BLUE CROSS BLUE SHIELD GR
VA
01
—
012879
BLUE CROSS BLUE SHIELD
VA
01
—
130000057
MEDICARE ID TYPE UNSPECIF
VA
01
—
220633
OPTIMUM CHOICE
VA
01
—
C09633
GROUP PTAN BON SECOURS
VA
Enumeration date
11/21/2007
Last updated
10/01/2012
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