Provider Demographics
NPI:1245294701
Name:CONCODORA, JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:CONCODORA
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 1:9105 STONY POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-1979
Mailing Address - Country:US
Mailing Address - Phone:804-287-1030
Mailing Address - Fax:804-288-3529
Practice Address - Street 1:9105 STONY POINT PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-1979
Practice Address - Country:US
Practice Address - Phone:804-287-1030
Practice Address - Fax:804-288-3529
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 026311208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1576OtherCARENET
VA23308OtherSENTARA FAMILY CARE
VA738307OtherAETNA HMO
VA323385OtherALLIANCE
VA425966900OtherTRICARE
VA1900008OtherUNITED HEALTHCARE
VA340014318OtherRAILROAD MEDICARE
VA4400145OtherAETNA PPO
VAC05484OtherMEDICARE GROUP #
VA090667000-00OtherQUALCHOICE
VA007501978Medicaid
VA2540OtherCIGNA
VA76653OtherSOUTHERN HEALTH
VACA4542OtherRAILROAD MEDICARE GROUP #
VAB60016Medicare UPIN
VA090667000-00OtherQUALCHOICE
VA2540OtherCIGNA
VA425966900OtherTRICARE