Provider Demographics
NPI:1619027471
Name:JOSEPH, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
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 1:4647 MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-1771
Mailing Address - Country:US
Mailing Address - Phone:910-755-6606
Mailing Address - Fax:910-755-6608
Practice Address - Street 1:4647 MAIN ST
Practice Address - Street 2:STE. 5
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-1905
Practice Address - Country:US
Practice Address - Phone:910-755-6606
Practice Address - Fax:910-755-6608
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-013322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAD12744Medicare UPIN