Provider Demographics
NPI:1235249186
Name:GARRITANO ROGER, JOANNA CONCETTA
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:CONCETTA
Last Name:GARRITANO ROGER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JOANNA
Other - Middle Name:C
Other - Last Name:GARRITANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:10452 SILVERDALE WAY NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9411
Mailing Address - Country:US
Mailing Address - Phone:360-307-7300
Mailing Address - Fax:
Practice Address - Street 1:10452 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9411
Practice Address - Country:US
Practice Address - Phone:360-307-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044356207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039578OtherLABOR & INDUSTRY
WA4356GAOtherBLUE SHIELD
WA8417172Medicaid
WA8857832Medicare PIN
WA8417172Medicaid