Provider Demographics
NPI:1003836636
Name:ALBANO, JOSEPH J (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:ALBANO
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:PO BOX 71547
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0547
Mailing Address - Country:US
Mailing Address - Phone:385-220-9009
Mailing Address - Fax:
Practice Address - Street 1:6360 S 3000 E
Practice Address - Street 2:210
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-6923
Practice Address - Country:US
Practice Address - Phone:385-220-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2693081205204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005511928Medicare ID - Type Unspecified
UTF72985Medicare UPIN