Provider Demographics
NPI:1881664571
Name:DISABATO, JOSEPH R (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:DISABATO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S PANTOPS DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8617
Mailing Address - Country:US
Mailing Address - Phone:434-977-8040
Mailing Address - Fax:434-977-8083
Practice Address - Street 1:103 S PANTOPS DR
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8617
Practice Address - Country:US
Practice Address - Phone:434-977-8040
Practice Address - Fax:434-977-8083
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000933213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009300660Medicaid
VA020497OtherBLUE SHIELD
VA480016878OtherRAILROAD MEDICARE
VAU05575Medicare UPIN
VA480016878OtherRAILROAD MEDICARE
VA009300660Medicaid