Provider Demographics
NPI:1912013186
Name:MCALDUFF, JOEL DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DAVID
Last Name:MCALDUFF
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 1:5565 STERRETT PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2665
Mailing Address - Country:US
Mailing Address - Phone:410-772-6658
Mailing Address - Fax:
Practice Address - Street 1:10980 GRANTCHESTER WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-6097
Practice Address - Country:US
Practice Address - Phone:410-772-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29501207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG91732Medicare UPIN