Provider Demographics
NPI:1790874063
Name:JOSEPH, COLLEEN ANNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:ANNE
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:COLLEEN
Other - Middle Name:ANNE
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1515 CHAINBRIDGE RD
Mailing Address - Street 2:G 17
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101
Mailing Address - Country:US
Mailing Address - Phone:703-356-1927
Mailing Address - Fax:703-356-2223
Practice Address - Street 1:1515 CHAINBRIDGE RD
Practice Address - Street 2:G 17
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101
Practice Address - Country:US
Practice Address - Phone:703-356-1927
Practice Address - Fax:703-356-2223
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD19696207W00000X
MDD0043488207W00000X
VA0101048273207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
720891M51Medicare ID - Type Unspecified
E92282Medicare UPIN