Provider Demographics
NPI:1659734358
Name:JOSEPH, SIJO V (MD)
Entity Type:Individual
Prefix:DR
First Name:SIJO
Middle Name:V
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-5189
Mailing Address - Fax:315-464-7494
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:DEPT OF MEDICINE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-2284
Practice Address - Fax:410-554-2184
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
NY3007862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program