Provider Demographics
NPI:1124173976
Name:SHIGO, JOHN JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:SHIGO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:417 SCARBURGH WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-6212
Mailing Address - Country:US
Mailing Address - Phone:301-537-9850
Mailing Address - Fax:707-539-5511
Practice Address - Street 1:417 SCARBURGH WAY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-6212
Practice Address - Country:US
Practice Address - Phone:301-537-9850
Practice Address - Fax:707-539-5511
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042043208D00000X
VA010142043363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB92985Medicare UPIN