Provider Demographics
NPI:1710106067
Name:JOSEPH, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:2001 CRYSTAL SPRING AVE SW
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2462
Mailing Address - Country:US
Mailing Address - Phone:540-853-0100
Mailing Address - Fax:540-342-9308
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2462
Practice Address - Country:US
Practice Address - Phone:540-853-0100
Practice Address - Fax:540-342-9308
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101-2565702086S0102X, 208G00000X, 208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)