Provider Demographics
NPI:1457333262
Name:JOSEPH, RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
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 1:165 CAREY AVE
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2112
Mailing Address - Country:US
Mailing Address - Phone:570-825-0770
Mailing Address - Fax:570-825-0922
Practice Address - Street 1:165 CAREY AVE
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2112
Practice Address - Country:US
Practice Address - Phone:570-825-0770
Practice Address - Fax:570-825-0922
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-021137E207R00000X
PAMD021137E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006009520002Medicaid
PA002744OtherFPH
PA14470OtherGHP
PAC27836Medicare UPIN
PA14470OtherGHP