Provider Demographics
NPI:1215977962
Name:NORTH, JOHN M (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:NORTH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2730-B PROSPERITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4330
Mailing Address - Country:US
Mailing Address - Phone:703-289-1400
Mailing Address - Fax:703-289-1414
Practice Address - Street 1:2730-A PROSPERITY AVENUE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4330
Practice Address - Country:US
Practice Address - Phone:703-289-1400
Practice Address - Fax:703-289-1414
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA01010440502080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6717811Medicaid
VA6717829Medicaid
VA6746047Medicaid
VA6717811Medicaid