Provider Demographics
NPI:1295966935
Name:BOZZO, JOSEPH CHARLES (PA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:CHARLES
Last Name:BOZZO
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:2200 HAMILTON ST STE 317
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6359
Mailing Address - Country:US
Mailing Address - Phone:610-481-9600
Mailing Address - Fax:
Practice Address - Street 1:2200 HAMILTON ST STE 308
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6359
Practice Address - Country:US
Practice Address - Phone:610-481-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054052363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032586800001Medicaid