DR. JOHN WILLIAM SUMMERVILLE (NPI# 1982604120) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982604120 |
| Entity Type | Individual |
| Full Name | DR. JOHN WILLIAM SUMMERVILLE |
| Credential | MD |
| Practice Address |
200 Medical Park Blvd Petersburg VA 23805 |
| Mailing Address |
5301 Virginia Way Ste 300 Brentwood TN 37027-7542 |
| Practice Telephone | 6152214400 |
| Mailing Telephone | 6152214400 |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2019-06-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207ZP0102X |
Pathology Specialization: Anatomic Pathology & Clinical Pathology |
0101041829 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 006603858 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 200 Medical Park Blvd, Petersburg, VA 238059274 | 8047655000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265471247 | John W Summerville | Dentist | 8 Essex Way, Suite 100, Essex Jct, VT 05452-3425 | 2006-06-05 |
| Street Address |
200 MEDICAL PARK BLVD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902413636 | Delesa Shana Kay Walden | Registered Nurse | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-09-27 |
| 1992339436 | Amy Kathryn Lansing | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-24 |
| 1588296453 | Erin Elise Layne | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-02-10 |
| 1295374643 | Crystal Leigh Maddox | Physical Therapist | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2020-01-02 |
| 1366081911 | Joshua Paul Pidcoe | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-12-31 |
| 1720623853 | Bon Secours Mercy Health Petersburg LLC | General Acute Care Hospital | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-11-13 |
| 1144874686 | Nina Thi Ong-pham | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-08-01 |
| 1720543507 | Martina Rochelle Washington | Specialist/Technologist, Other | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2019-02-05 |
| 1356812242 | Ams Virginia Pllc | Nurse Anesthetist, Certified Registered | 200 Medical Park Blvd, Petersburg, VA 23805 | 2018-12-17 |
| 1841761079 | Erin Collins | Physician Assistant | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2018-12-16 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 207ZP0102X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pathology |
| Specialization | Anatomic Pathology & Clinical Pathology |
| A pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the laboratory application of the biologic, chemical and physical sciences. A pathologist uses information gathered from the microscopic examination of tissue specimens, cells and body fluids, and from clinical laboratory tests on body fluids and secretions for the diagnosis, exclusion and monitoring of disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added, 7/1/2009: definition reformatted] Additional Resources: American Board of Pathology, 2007. http://www.abpath.org/ This taxonomy code identifies the combined anatomic pathology & clinical pathology route. Board certification for Medical Doctors (MDs) is provided by the American Board of Pathology. To acknowledge the diverse activities in the practice of pathology and to accommodate the interests of individuals wanting to enter the field, the ABP offers primary certification through the following three routes: combined anatomic pathology and clinical pathology, anatomic pathology only and clinical pathology only. Primary certification in anatomic pathology or clinical pathology may be combined with some of the subspecialty certifications. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154493534 | Edward P. Nikicicz, M.d., P.C. | Pathology | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2006-11-14 |
| 1871679704 | Petersburg Pathology Associates Ltd. | Pathology | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2006-10-31 |
| 1447349444 | Manuel Borja Gonzales | Pathology | 801 S Adams St, Laboratory, Petersburg, VA 23803-5149 | 2006-10-11 |
| 1639267040 | Edward Peter Nikicicz | Pathology | 801 S Adams St, Srmc, Lab, Petersburg, VA 23803-5149 | 2006-10-11 |
| 1932170909 | Brad Thomas Siegmund | Pathology | 200 Medical Park Blvd, Petersburg, VA 23805-9274 | 2006-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952821308 | Patricija Zot | Pathology | 1250 E Marshall St # 980662, Richmond, VA 23298-5051 | 2017-06-26 |
| 1508248949 | Rajeswari Jayakumar | Pathology | 403 N. 13th Street, Csc, Richmond, VA 23298 | 2015-06-22 |
| 1891192209 | Pepper Path LLC | Pathology | 45945 Trefoil Ln, Unit 175, Sterling, VA 20166-4343 | 2014-12-01 |
| 1477953578 | Jonathan Edwards | Pathology | Bon Secours Mary Immaculate Hospital, Pathology Dept, 2 Bernardine Dr, Newport News, VA 23602 | 2014-08-26 |
| 1629481700 | David Phillip Lebel II | Pathology | 1 Riverside Cir Ste 105, Roanoke, VA 24016-4961 | 2014-06-06 |
| 1710304761 | Sara Ali Mustafa | Pathology | 3289 Woodburn Rd Ste 220, Annandale, VA 22003-7313 | 2014-03-27 |
| 1215376959 | Angela Yu-jye Wu | Pathology | 1215 Lee Street - Box Number 800214, Charlottesville, VA 22908-0001 | 2013-06-16 |
| 1043529365 | Alden W Dudley Jr. | Pathology | 5909 Winnbrook Dr, Roanoke, VA 24018-7903 | 2010-10-04 |
| 1649582412 | Vasavi Kaliki | Pathology | 4505 Yorkminster Dr, Glen Allen, VA 23060-6157 | 2010-07-09 |
| 1063737146 | William F. Enos, M.d., Pllc | Pathology | 10300 Spotsylvania Avenue, Suite 130, Fredericksburg, VA 22408 | 2010-04-01 |
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| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.