Provider Demographics
NPI:1306839576
Name:STAAB, JOSEPH J (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:STAAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100523
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-0523
Mailing Address - Country:US
Mailing Address - Phone:843-669-5162
Mailing Address - Fax:843-667-4573
Practice Address - Street 1:1000 W HAMLET AVE
Practice Address - Street 2:MEDICAL IMAGING
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-4522
Practice Address - Country:US
Practice Address - Phone:910-205-8155
Practice Address - Fax:910-205-8003
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5668-S2085R0202X
NC2007-011542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2037030Medicaid
NC5907191Medicaid
NC2069852Medicare PIN
NC5907191Medicaid