Provider Demographics
NPI:1447228366
Name:MUCCIOLO, JOSEPH M JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:MUCCIOLO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:25 LYSTRA ROGERS DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-8807
Practice Address - Country:US
Practice Address - Phone:570-523-3290
Practice Address - Fax:570-524-5231
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD067194L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018668060003Medicaid
PA050880Medicare PIN
PA0018668060003Medicaid