Provider Demographics
NPI:1902962244
Name:PHILBRICK, JOHN T (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:PHILBRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:500 RAY C HUNT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2981
Mailing Address - Country:US
Mailing Address - Phone:434-980-6140
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:UNIVERSITY PHYSICIANS ORANGE
Practice Address - Street 2:661 UNIVERSITY LANE
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960
Practice Address - Country:US
Practice Address - Phone:540-661-3004
Practice Address - Fax:540-661-3060
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2008-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101032194207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005688990Medicaid
VA005688990Medicaid
VA111953189Medicare PIN