Provider Demographics
NPI:1003200866
Name:AZZARELLO, JOSEPH THADDEUS (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:THADDEUS
Last Name:AZZARELLO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 POCAHONTAS ST STE 400
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-2428
Mailing Address - Country:US
Mailing Address - Phone:757-910-3009
Mailing Address - Fax:
Practice Address - Street 1:1180 POCAHONTAS ST STE 400
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-2428
Practice Address - Country:US
Practice Address - Phone:757-910-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32678171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK32678OtherSTATE MEDICAL LICENSE