Provider Demographics
NPI:1144214107
Name:JOSEPH, THRESIAMMA AUGUSTINE (MD)
Entity Type:Individual
Prefix:
First Name:THRESIAMMA
Middle Name:AUGUSTINE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3585 LEXINGTON AVE N
Mailing Address - Street 2:STE 350
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-8064
Mailing Address - Country:US
Mailing Address - Phone:651-251-5280
Mailing Address - Fax:651-251-5282
Practice Address - Street 1:3585 LEXINGTON AVE N
Practice Address - Street 2:STE 350
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-8064
Practice Address - Country:US
Practice Address - Phone:651-484-3942
Practice Address - Fax:651-787-0519
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN320362080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1201379OtherMEDICA
MN299L3J0OtherBLUE CROSS BLUE SHEILD
MNCP9090199004OtherPREFERRED ONE
MN1203070OtherMEDICA
A96960Medicare UPIN