Provider Demographics
NPI:1013032812
Name:LIBRICZ, JOSEPH JOHN JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:JOHN
Last Name:LIBRICZ
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:95 E WAYNE AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4244
Mailing Address - Country:US
Mailing Address - Phone:301-589-3977
Mailing Address - Fax:
Practice Address - Street 1:5255 LOUGHBORO RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2633
Practice Address - Country:US
Practice Address - Phone:301-589-3977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA-C030486363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical