Provider Demographics
NPI:1346319514
Name:ROEDDER, JOSEPH EDWARD JR (CPED)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDWARD
Last Name:ROEDDER
Suffix:JR
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:36 N PARKE ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2436
Mailing Address - Country:US
Mailing Address - Phone:410-272-0383
Mailing Address - Fax:410-272-2627
Practice Address - Street 1:36 N PARKE ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2436
Practice Address - Country:US
Practice Address - Phone:410-272-0383
Practice Address - Fax:410-272-2627
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies