Individual
JO BAYLISS DEVIVO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
163 THOMAS JOHNSON DR STE H, FREDERICK, MD 21702-4673
(301) 694-9111
Mailing address
11107 ROCK GARDEN DR, FAIRFAX, VA 22030-4935
(843) 618-8457
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110009528
VA
Other
Enumeration date
09/07/2023
Last updated
03/01/2024
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