Provider Demographics
NPI:1588632574
Name:LARRAZABAL, JOHANNA D (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:D
Last Name:LARRAZABAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:
Practice Address - Street 1:5231 JOHN TYLER HWY
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2553
Practice Address - Country:US
Practice Address - Phone:757-220-8300
Practice Address - Fax:757-565-5338
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238426207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I43565Medicare UPIN
VA1588632574Medicaid
VAP00756829Medicare PIN
VA020465R53Medicare PIN