Provider Demographics
NPI:1972501906
Name:PROEBSTLE, JOSEPH GERARD (DPM)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GERARD
Last Name:PROEBSTLE
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 1:8023 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-7107
Mailing Address - Country:US
Mailing Address - Phone:410-761-3338
Mailing Address - Fax:410-761-0265
Practice Address - Street 1:8023 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-7107
Practice Address - Country:US
Practice Address - Phone:410-761-3338
Practice Address - Fax:410-761-0265
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01059213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDCD0XJGOtherBLUE CROSS BLUE SHIELD
MD455037358OtherTRICARE
MD359218900Medicaid
MDDS9585OtherRAILROAD MEDICARE
MDAC99OtherBLUE CHOICE
MDT58726Medicare UPIN
MDAC99OtherBLUE CHOICE
MDDS9585OtherRAILROAD MEDICARE