Individual
JONATHAN ANTHONY SHOMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
110A N MAIN ST, BRIDGEWATER, VA 22812-1301
(540) 515-4325
(540) 210-1271
Mailing address
110A N MAIN ST, BRIDGEWATER, VA 22812-1301
(540) 515-4325
(540) 210-1271
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002842
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689822652
—
VA
Enumeration date
09/03/2008
Last updated
08/19/2021
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