Provider Demographics
NPI:1316932809
Name:WIERZBICKI, JOHN JAMES (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAMES
Last Name:WIERZBICKI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:3401 COMMISSION CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1771
Mailing Address - Country:US
Mailing Address - Phone:703-490-6265
Mailing Address - Fax:703-490-6713
Practice Address - Street 1:3401 COMMISSION CT STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1771
Practice Address - Country:US
Practice Address - Phone:703-490-6265
Practice Address - Fax:703-490-6713
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102201607207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2401672Medicare PIN
NC5910500Medicaid