Provider Demographics
NPI:1629086657
Name:JOSEPH, MICHAEL P (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1219
Mailing Address - Country:US
Mailing Address - Phone:207-897-6601
Mailing Address - Fax:207-897-4339
Practice Address - Street 1:105 MT BLUE CIR
Practice Address - Street 2:SUITE 2
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6239
Practice Address - Country:US
Practice Address - Phone:207-779-2640
Practice Address - Fax:207-779-2642
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME017611207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433271199Medicaid
ME433271199Medicaid
B97545Medicare UPIN
ME000337001Medicare PIN