Provider Demographics
NPI:1649264169
Name:GO, JENNIE R (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:R
Last Name:GO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10319 WESTLAKE DRIVE
Mailing Address - Street 2:#393
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:267-234-2729
Mailing Address - Fax:
Practice Address - Street 1:10319 WESTLAKE DR
Practice Address - Street 2:#393
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6403
Practice Address - Country:US
Practice Address - Phone:267-234-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD420080207Q00000X
MDD0064928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine