Provider Demographics
NPI:1700855368
Name:DAMBRAUSKAS, JOSEPH JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:DAMBRAUSKAS
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 1:1005 S 6TH ST
Mailing Address - Street 2:APT 15
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-6227
Mailing Address - Country:US
Mailing Address - Phone:217-344-2646
Mailing Address - Fax:217-344-2646
Practice Address - Street 1:722 SARAH STREET
Practice Address - Street 2:LEFT FRONT
Practice Address - City:CARNEGIE
Practice Address - State:PA
Practice Address - Zip Code:15106-0112
Practice Address - Country:US
Practice Address - Phone:708-262-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2067372084P0804X
NM2002-04032084P0804X
PAMD027571E2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1830797Medicaid
E91716Medicare UPIN