Provider Demographics
NPI:1841301769
Name:AVERY,III, JOSEPH HENRY (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HENRY
Last Name:AVERY,III
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 1:10403 HOSPITAL DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3134
Mailing Address - Country:US
Mailing Address - Phone:301-877-4210
Mailing Address - Fax:301-856-8994
Practice Address - Street 1:10403 HOSPITAL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3134
Practice Address - Country:US
Practice Address - Phone:301-877-4210
Practice Address - Fax:301-856-8994
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034671207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC48291Medicare UPIN
DE9428OtherKAISER
DCA123-0001OtherCAREFIRST BLUE CROSS
DE1462425OtherUNITED HEALTH CARE
DC130332Medicare PIN
DC4133712OtherAETNA
DC41530OtherAETNA
DC817127OtherMDIPA / OPTIMUM CHOICE
DC910900OtherANTHEM BLUE CROSS/HEALTHK
DC025922700Medicaid
DC05205OtherAMERIGROUP
DC217127OtherMAMSI / ALLIANCE
DC6535012OtherCIGNA
DCC48291Medicare UPIN