Provider Demographics
NPI:1376876474
Name:AVELLONE, JOSEPH CHARLES III (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CHARLES
Last Name:AVELLONE
Suffix:III
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 1:21 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-3106
Mailing Address - Country:US
Mailing Address - Phone:781-237-6246
Mailing Address - Fax:
Practice Address - Street 1:21 ELM ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-3106
Practice Address - Country:US
Practice Address - Phone:781-237-6246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA39449208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery