Provider Demographics
NPI:1669581500
Name:LENNON, JOHN R IV (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LENNON
Suffix:IV
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 KINGSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4999
Mailing Address - Country:US
Mailing Address - Phone:757-842-4481
Mailing Address - Fax:757-312-3135
Practice Address - Street 1:1034 BATTLEFIELD BLVD S STE 100
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-4215
Practice Address - Country:US
Practice Address - Phone:757-312-2299
Practice Address - Fax:757-312-2256
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08694363A00000X
VA0110002100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q52078Medicare UPIN
008561C83Medicare ID - Type Unspecified