Individual
DR. JAMES RUSSELL HENGERER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2321 ATHERHOLT RD, SUITE B, LYNCHBURG, VA 24501-2113
(434) 947-3993
(434) 847-2941
Mailing address
2849 LINK RD, LYNCHBURG, VA 24503-3217
(434) 384-8745
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
0101032236
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006030
ANTHEM
VA
05
—
006590896
—
VA
01
—
54-04894959
FEDERAL TAX ID #
VA
Enumeration date
06/30/2005
Last updated
10/25/2011
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