Provider Demographics
NPI: | 1629150065 |
---|---|
Name: | GIORDANO, JOSEPH ANGELO (PA) |
Entity Type: | Individual |
Prefix: | |
First Name: | JOSEPH |
Middle Name: | ANGELO |
Last Name: | GIORDANO |
Suffix: | |
Gender: | M |
Credentials: | PA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 60447 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28260-0447 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 704-384-5416 |
Mailing Address - Fax: | 704-384-5992 |
Practice Address - Street 1: | 1500 MATTHEWS TOWNSHIP PKWY |
Practice Address - Street 2: | |
Practice Address - City: | MATTHEWS |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28105-4656 |
Practice Address - Country: | US |
Practice Address - Phone: | 704-384-9740 |
Practice Address - Fax: | 704-384-9565 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-19 |
Last Update Date: | 2023-05-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 0010-00604 | 363A00000X, 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 1629150065 | Medicaid | |
SC | 0630PA | Medicaid | |
NC | 8101108 | Medicaid | |
NC | NC1233A | Medicare PIN | |
NC | NC1233B | Medicare PIN | |
NC | 2759121A | Medicare PIN |