Provider Demographics
NPI:1588685887
Name:GO, MARIE BEVERLY U (MD)
Entity type:Individual
Prefix:DR
First Name:MARIE BEVERLY
Middle Name:U
Last Name:GO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 SANDLER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-9432
Mailing Address - Country:US
Mailing Address - Phone:850-656-2459
Mailing Address - Fax:
Practice Address - Street 1:1607 SAINT JAMES CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5352
Practice Address - Country:US
Practice Address - Phone:850-878-0191
Practice Address - Fax:850-878-8900
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME927222084P0800X
TN200442084P0800X
GA0555212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3068652Medicare ID - Type Unspecified
TNF31301Medicare UPIN