John Deitrick MD Consulting, LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

0101037598 Issued in VA

Legal business name

JOHN DEITRICK MD CONSULTING, LLC

Practice address

173 Wadsworth Dr
North Chesterfield, VA 23236-4500

Phone

(804) 674-5957

NPI assigned

Jun 4, 2018

Last updated

Feb 18, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John C Deitrick, MD

Title

Owner

Phone

(804) 241-5911

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1528070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1528550654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8987",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232250687",
            "telephone_number": "804-241-5911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "173 WADSWORTH DR",
            "city": "NORTH CHESTERFIELD",
            "state": "VA",
            "postal_code": "232364500",
            "telephone_number": "804-674-5957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN DEITRICK MD CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-04",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A",
        "authorized_official_last_name": "DEITRICK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-241-5911",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "VA",
            "license": "0101037598",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1457338741",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nikole Rohana Jiggetts, LCSW
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• Colleen John
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• Kimone Latoya Johns, DNP, FNP-BC, PMHNP-B
• Alease Baskfield Johnson, LPC, NCC
• Aliyah Johnson

• Vascular Surgery Physician in North Chesterfield, VA
• Providers in North Chesterfield, VA by specialty
• Vascular Surgery Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.