Individual
DR. JOHN L. HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3300 RIVERMONT AVE, LYNCHBURG, VA 24503-2030
(434) 200-5999
Mailing address
1204 FENWICK DR, LYNCHBURG, VA 24502-2112
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
0101053066
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
132551
VALUE OPTIONS PROVIDER NU
—
01
—
186463
ANTHEM PROVIDER NUMBER
—
01
—
2016147
CIGNA BEHAVIOR PROVIDER N
—
01
—
203639329001
TRICARE PROVIDER NUMBER
—
01
—
O87204
SENTARA/OPTIMA PROVIDER N
—
Enumeration date
07/21/2005
Last updated
03/12/2008
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