Provider Demographics
NPI:1346247905
Name:NORRIS, JOSEPH D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:NORRIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-4421
Mailing Address - Country:US
Mailing Address - Phone:215-389-7766
Mailing Address - Fax:215-389-0227
Practice Address - Street 1:1028 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4421
Practice Address - Country:US
Practice Address - Phone:215-389-7766
Practice Address - Fax:215-389-0227
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA000866363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010831600001Medicaid