Provider Demographics
NPI:1245276161
Name:WAND, JOSEPH STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:STEPHEN
Last Name:WAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:STEPHEN
Other - Last Name:WAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3715 NIELSEN RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1723
Mailing Address - Country:US
Mailing Address - Phone:707-527-7968
Mailing Address - Fax:
Practice Address - Street 1:3715 NIELSEN RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1723
Practice Address - Country:US
Practice Address - Phone:707-527-7968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG274750207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43366Medicare UPIN