Provider Demographics
NPI:1003860040
Name:TALAVERA, JOYCE R (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:R
Last Name:TALAVERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 MOUNTAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-2638
Mailing Address - Country:US
Mailing Address - Phone:908-222-0048
Mailing Address - Fax:908-222-3709
Practice Address - Street 1:202 ELMER ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2128
Practice Address - Country:US
Practice Address - Phone:908-228-3675
Practice Address - Fax:908-654-1053
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08692700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ25222OtherBLUE CROSS BLUE SHIELD
MA215116OtherTUFTS HEALTH PLAN
MA0178951Medicare ID - Type Unspecified
MA215116OtherTUFTS HEALTH PLAN
MAH66868Medicare UPIN