Provider Demographics
NPI:1558332932
Name:FITZHARRIS, JOAN GO (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:GO
Last Name:FITZHARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:M
Other - Last Name:GO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3920A BRIDGE RD
Mailing Address - Street 2:SUITE 207 SENTARA FAMILY PRACTICE
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435
Mailing Address - Country:US
Mailing Address - Phone:757-983-2200
Mailing Address - Fax:757-257-9991
Practice Address - Street 1:3920A BRIDGE RD
Practice Address - Street 2:SUITE 207 SENTARA FAMILY PRACTICE
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435
Practice Address - Country:US
Practice Address - Phone:757-983-2200
Practice Address - Fax:757-257-9991
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA41667207R00000X
VA01012400051207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN