Provider Demographics
NPI:1326553157
Name:FRITZ, MARY JO
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:FRITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2978 BIRCH CREEK CT
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-3383
Mailing Address - Country:US
Mailing Address - Phone:703-221-5041
Mailing Address - Fax:202-324-0396
Practice Address - Street 1:2978 BIRCH CREEK CT
Practice Address - Street 2:
Practice Address - City:DUMFRIES
Practice Address - State:VA
Practice Address - Zip Code:22026-3383
Practice Address - Country:US
Practice Address - Phone:703-221-5041
Practice Address - Fax:202-324-0369
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA172A00000X
172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver