Provider Demographics
NPI:1700848637
Name:JOSEPH, PETER M (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 E NORTH AVE STE 405
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4740
Mailing Address - Country:US
Mailing Address - Phone:412-359-8079
Mailing Address - Fax:412-359-8070
Practice Address - Street 1:490 E NORTH AVE STE 405
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4740
Practice Address - Country:US
Practice Address - Phone:412-359-8079
Practice Address - Fax:412-359-8070
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002229L213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000815947Medicaid
PA1240918OtherCIGNA
PA000072588OtherHIGHMARK
PA000815947Medicaid
PA1280538OtherHEALTH AMERICA
PAT28172Medicare UPIN
PA000815947Medicaid