Provider Demographics
NPI:1518940758
Name:JAWORSKI,, JOSEPH EDGAR (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:EDGAR
Last Name:JAWORSKI,
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 TRUMPS HILL RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4936
Mailing Address - Country:US
Mailing Address - Phone:301-627-3831
Mailing Address - Fax:301-870-9722
Practice Address - Street 1:12070 OLD LINE CTR
Practice Address - Street 2:SUITE 302
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2513
Practice Address - Country:US
Practice Address - Phone:301-645-6667
Practice Address - Fax:301-870-9722
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001477363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS96694Medicare UPIN