Provider Demographics
NPI:1326087875
Name:JOSEPH, LERLA GEORGETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:LERLA
Middle Name:GEORGETTE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 HULL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-4069
Mailing Address - Country:US
Mailing Address - Phone:804-230-4913
Mailing Address - Fax:800-609-6810
Practice Address - Street 1:849 S SYCAMORE ST STE A
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5801
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010136044207R00000X
VA0101036044207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000101256OtherCIGNA
VA055645OtherBLUE CROSS BLUE SHIELD
VA6063802Medicaid
VA055645OtherBLUE CROSS BLUE SHIELD
B06740Medicare UPIN