Provider Demographics
NPI:1659399491
Name:JOSEPH, PRIYA ERATHARA (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:ERATHARA
Last Name:JOSEPH
Suffix:
Gender:F
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 BLYTHE BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5812
Practice Address - Country:US
Practice Address - Phone:704-355-0720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01565208M00000X, 207R00000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02798350Medicaid
PA1017508680001Medicaid
NC5917710Medicaid
PAMD429448OtherMEDICAL LICENSE
PACC9269OtherRR MEDICARE GROUP
NC1659399491Medicaid
PAP00324434OtherRR MEDICARE PIN
PAGU039812OtherMEDICARE GROUP
SCNC1341Medicaid
NC1659399491Medicaid
NC2077449Medicare PIN