Provider Demographics
NPI:1275552507
Name:HARRIS, SONJA FREDRICKSON (MD)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:FREDRICKSON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SONJA
Other - Middle Name:K
Other - Last Name:FREDRICKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1201 BROAD ROCK BLVD
Mailing Address - Street 2:171
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249-0001
Mailing Address - Country:US
Mailing Address - Phone:804-675-5535
Mailing Address - Fax:804-675-5139
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:171
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5535
Practice Address - Fax:804-675-5139
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-058961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine