Provider Demographics
NPI:1376766816
Name:ESSEPIAN, JOHN PHILLIP III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:PHILLIP
Last Name:ESSEPIAN
Suffix:III
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 1:3031 JAVIER RD
Mailing Address - Street 2:STE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4637
Mailing Address - Country:US
Mailing Address - Phone:703-698-8880
Mailing Address - Fax:703-698-8884
Practice Address - Street 1:3031 JAVIER RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4638
Practice Address - Country:US
Practice Address - Phone:703-698-8880
Practice Address - Fax:703-698-8884
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051247207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101051247OtherMEDICAL LICENSE
VA0101051247OtherMEDICAL LICENSE