Provider Demographics
NPI:1215025200
Name:GUARNIERI, JOHNSTUART M (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNSTUART
Middle Name:M
Last Name:GUARNIERI
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 1:333 MCLAWS CIR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6339
Mailing Address - Country:US
Mailing Address - Phone:757-345-2275
Mailing Address - Fax:757-229-3435
Practice Address - Street 1:333 MCLAWS CIR
Practice Address - Street 2:SUITE 3
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6339
Practice Address - Country:US
Practice Address - Phone:757-345-2275
Practice Address - Fax:757-229-3435
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101041390208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA292271OtherANTHEM
VA006901913Medicaid
VA480669OtherMDIPA
GAP00108974OtherRAILROAD MEDICARE
VA27607OtherSENTARA
SC450470381OtherTRICARE
SC450470381OtherTRICARE
VA240000275Medicare PIN