Provider Demographics
NPI:1376579391
Name:JOSEPH, ANSON (MD,)
Entity Type:Individual
Prefix:DR
First Name:ANSON
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 HOSPITAL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4057
Mailing Address - Country:US
Mailing Address - Phone:410-535-4333
Mailing Address - Fax:410-535-3260
Practice Address - Street 1:130 HOSPITAL RD STE 300
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4057
Practice Address - Country:US
Practice Address - Phone:410-535-4333
Practice Address - Fax:410-535-3260
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56161207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD098860000OtherPREFERRED HEALTH NETWORK
MDD56161OtherSTATE LICENSE NUMBER
MD0J48JAOtherBLUE CROSS / BLUE SHEILD
1201465OtherAMERIGROUP
MD110225745OtherMEDICARE RAIL ROAD
MD8092036.00Medicaid
558ROtherMEDICARE PTAN
MDM51736OtherCDS NUMBER
015496OtherPRIORITY PARTNERS
2683588OtherAETNA
2683588OtherAETNA
MDBJ7171678OtherDEA