Provider Demographics
NPI:1639190499
Name:PATICOFF, JOSHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:PATICOFF
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 1:600 CROSS POINTE RD STE A
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6696
Mailing Address - Country:US
Mailing Address - Phone:513-725-2186
Mailing Address - Fax:
Practice Address - Street 1:4355 FERGUSON DR STE 270
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-5137
Practice Address - Country:US
Practice Address - Phone:513-718-0115
Practice Address - Fax:513-718-0116
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234358207LP2900X
OH35.130894207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0217844Medicaid