Provider Demographics
NPI:1154588374
Name:JOSEPHSON, JOHN WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:JOSEPHSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3903 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2943
Mailing Address - Country:US
Mailing Address - Phone:571-349-2191
Mailing Address - Fax:571-349-2211
Practice Address - Street 1:3998 FAIR RIDGE DR STE 105
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2980
Practice Address - Country:US
Practice Address - Phone:571-349-2191
Practice Address - Fax:571-349-2211
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115946207W00000X
390200000X
VA0101252106207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program