Provider Demographics
NPI:1790874063
Name:JOSEPH, COLLEEN ANNE (MD)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANNE
Last Name:JOSEPH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:ANNE
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2661 RIVA RD STE 1030
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7131
Mailing Address - Country:US
Mailing Address - Phone:410-571-8733
Mailing Address - Fax:410-571-6309
Practice Address - Street 1:6845 ELM ST STE 250
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6048
Practice Address - Country:US
Practice Address - Phone:703-356-5484
Practice Address - Fax:703-356-2223
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD19696207W00000X
MDD0043488207W00000X
VA0101048273207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
720891M51Medicare ID - Type Unspecified
E92282Medicare UPIN