Basic Information
| Provider Information | |||||||||
| NPI: | 1326069238 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ANSON J JOSEPH - PATUXENT NEPHROLOGY ASSOC LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | NEPHROLOGY AND HYPERTENSION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2424 | ||||||||
| Address2: | |||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206782424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105352985 | ||||||||
| FaxNumber: | 4105350404 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 STEEPLE CHASE DR | ||||||||
| Address2: | SUITE #206 | ||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206784053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105352085 | ||||||||
| FaxNumber: | 4105350404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/23/2006 | ||||||||
| LastUpdateDate: | 08/23/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JOSEPH | ||||||||
| AuthorizedOfficialFirstName: | ANSON | ||||||||
| AuthorizedOfficialMiddleName: | JACOB | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 4105352085 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | D56161 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 0J48JA | 01 | MD | BLUECROSS BLUE SHIELD | OTHER | D56161 | 01 | MD | MARYLAND STATE LICENSE | OTHER | 110225745 | 01 | MD | MEDICARE RAIL ROAD | OTHER | 391889 | 01 | MD | MAMSI | OTHER | 8092036.00 | 05 | MD | MEDICAID | F1170001 | 01 | DC | BLUE CROSS / BLUE SHEILD | OTHER | M51736 | 01 | MD | CDS | OTHER | 7743275 | 01 | MD | AETNA - PPO | OTHER | BJ7171678 | 01 | MD | DEA NUMBER | OTHER | 2683588 | 01 | MD | AETNA - HMO | OTHER |