Provider Demographics
NPI:1760431852
Name:MAX, JOEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:E
Last Name:MAX
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 1:101 W RIDGELY RD
Mailing Address - Street 2:STE 4B
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5101
Mailing Address - Country:US
Mailing Address - Phone:410-561-1960
Mailing Address - Fax:410-560-3497
Practice Address - Street 1:101 W RIDGELY RD
Practice Address - Street 2:STE 4B
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-5101
Practice Address - Country:US
Practice Address - Phone:410-561-1960
Practice Address - Fax:410-560-3497
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD47019207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD248900700Medicaid
MDKE39ROOtherBCBSMD
MDR270OtherBSDC
MDCI7619OtherRAILROAD MEDICARE
MDCI7619OtherRAILROAD MEDICARE
MD517L324YMedicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
MDKE39ROOtherBCBSMD
MDG94484Medicare UPIN
MD248900700Medicaid