Provider Demographics
NPI:1972501054
Name:CHODOS, JOEL E (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:E
Last Name:CHODOS
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 1:930 OLD HARMONY RD.
Mailing Address - Street 2:STE D
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4161
Mailing Address - Country:US
Mailing Address - Phone:302-455-1980
Mailing Address - Fax:302-455-1999
Practice Address - Street 1:930 OLD HARMONY RD.
Practice Address - Street 2:STE D
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4161
Practice Address - Country:US
Practice Address - Phone:302-455-1980
Practice Address - Fax:302-455-1999
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003147174400000X
DEC1-0003147207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE537983Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
DEA61092Medicare UPIN