Provider Demographics
NPI:1417949173
Name:JOSEPH, JOSEPH T (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
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 1:1466 NORTH HERMITAGE ROAD
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3105
Mailing Address - Country:US
Mailing Address - Phone:724-962-3633
Mailing Address - Fax:724-962-1503
Practice Address - Street 1:1466 NORTH HERMITAGE ROAD
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3105
Practice Address - Country:US
Practice Address - Phone:724-962-3633
Practice Address - Fax:724-962-1503
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039913L207R00000X
PAMD039913-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010744750001Medicaid
PAC34655Medicare UPIN
PA0010744750001Medicaid