Provider Demographics
NPI:1326069238
Name:ANSON J JOSEPH - PATUXENT NEPHROLOGY ASSOC LLC
Entity Type:Organization
Organization Name:ANSON J JOSEPH - PATUXENT NEPHROLOGY ASSOC LLC
Other - Org Name:NEPHROLOGY AND HYPERTENSION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ANSON
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-535-2085
Mailing Address - Street 1:PO BOX 2424
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-2424
Mailing Address - Country:US
Mailing Address - Phone:410-535-2985
Mailing Address - Fax:410-535-0404
Practice Address - Street 1:205 STEEPLE CHASE DR
Practice Address - Street 2:SUITE #206
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4053
Practice Address - Country:US
Practice Address - Phone:410-535-2085
Practice Address - Fax:410-535-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56161207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0J48JAOtherBLUECROSS BLUE SHIELD
MDD56161OtherMARYLAND STATE LICENSE
MD110225745OtherMEDICARE RAIL ROAD
MD391889OtherMAMSI
MD8092036.00Medicaid
DCF1170001OtherBLUE CROSS / BLUE SHEILD
MDM51736OtherCDS
MD7743275OtherAETNA - PPO
MD2683588OtherAETNA - HMO
MD2683588OtherAETNA - HMO
MDD56161OtherMARYLAND STATE LICENSE