Individual
DR. JOHN JOSEPH HENNESSEY IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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
0101031
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
—
220633
OPTIMUM CHOICE
VA
Enumeration date
04/25/2006
Last updated
10/10/2007
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