Basic Information
| Provider Information | |||||||||
| NPI: | 1376579391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPH | ||||||||
| FirstName: | ANSON | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 130 HOSPITAL RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206784057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105354333 | ||||||||
| FaxNumber: | 4105353260 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 HOSPITAL RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | PRINCE FREDERICK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 206784057 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105354333 | ||||||||
| FaxNumber: | 4105353260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D56161 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | D56161 | MD | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 098860000 | 01 | MD | PREFERRED HEALTH NETWORK | OTHER | D56161 | 01 | MD | STATE LICENSE NUMBER | OTHER | 0J48JA | 01 | MD | BLUE CROSS / BLUE SHEILD | OTHER | 1201465 | 01 | AMERIGROUP | OTHER | 110225745 | 01 | MD | MEDICARE RAIL ROAD | OTHER | 8092036.00 | 05 | MD | MEDICAID | 558R | 01 | MEDICARE PTAN | OTHER | M51736 | 01 | MD | CDS NUMBER | OTHER | BJ7171678 | 01 | MD | DEA | OTHER | 015496 | 01 | PRIORITY PARTNERS | OTHER | 2683588 | 01 | AETNA | OTHER |