Provider Demographics
NPI:1508065210
Name:IANNETTA, JOSHUA (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:IANNETTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:632 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9794
Mailing Address - Country:US
Mailing Address - Phone:207-883-1003
Mailing Address - Fax:207-883-5322
Practice Address - Street 1:632 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9794
Practice Address - Country:US
Practice Address - Phone:207-883-1003
Practice Address - Fax:207-883-5322
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1897204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM