Provider Demographics
NPI:1962401448
Name:KERR, JOHN MARTIN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
Last Name:KERR
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 1:58 CARROLL ST
Mailing Address - Street 2:SUITE 2D
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-883-8091
Mailing Address - Fax:276-883-8090
Practice Address - Street 1:58 CARROLL ST
Practice Address - Street 2:SUITE 2D
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-883-8091
Practice Address - Fax:276-883-8090
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8948728Medicaid
VA1962401448Medicaid
VA018040C18Medicare PIN
NC2158815AMedicare PIN
VA1962401448Medicaid
NCE82544Medicare UPIN
014732C80Medicare PIN