Provider Demographics
NPI:1073773321
Name:REGIS, JOANNA T (MD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:T
Last Name:REGIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 MERCANTILE LN
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5374
Mailing Address - Country:US
Mailing Address - Phone:301-618-5500
Mailing Address - Fax:301-618-5525
Practice Address - Street 1:1221 MERCANTILE LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5374
Practice Address - Country:US
Practice Address - Phone:301-618-5500
Practice Address - Fax:301-618-5525
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA116020108207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine