Provider Demographics
NPI:1720024474
Name:NEGLIA, JOSEPH P (MD, MPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:NEGLIA
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 RIVERSIDE AVE
Mailing Address - Street 2:MB665, 8952A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1450
Mailing Address - Country:US
Mailing Address - Phone:612-626-3113
Mailing Address - Fax:612-626-6601
Practice Address - Street 1:2450 RIVERSIDE AVE
Practice Address - Street 2:JOURNEY CLINIC
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1450
Practice Address - Country:US
Practice Address - Phone:612-365-8100
Practice Address - Fax:612-365-8101
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30219208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1010360OtherPREFERRED ONE
MN2T301NEOtherBCBS
36-21104OtherMEDICA CHOICE
MN494385600Medicaid
C002OtherCHAMPUS
CHAMPUS/TRICAREOtherB359
MT0046920Medicaid
36-00263OtherMEDICA PRIMARY
572379OtherARAZ
100986OtherUCARE
HP14032OtherHEALTPARTNERS
MN494385600Medicaid