Provider Demographics
NPI:1760417125
Name:DEVENUTO ., JOSEPH J JR (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:DEVENUTO .
Suffix:JR
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 1:485 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-3403
Mailing Address - Country:US
Mailing Address - Phone:215-345-6100
Mailing Address - Fax:215-345-4151
Practice Address - Street 1:329 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-1201
Practice Address - Country:US
Practice Address - Phone:215-945-0200
Practice Address - Fax:215-945-2424
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009403E207W00000X
NJ25MA03164800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ186841Medicare ID - Type Unspecified
PAC30680Medicare UPIN
PA119720Medicare ID - Type Unspecified