Basic Information
| Provider Information | |||||||||
| NPI: | 1417162439 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTHONY R JOSEPH MD LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5036 ELLIS LN | ||||||||
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| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210436853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107447593 | ||||||||
| FaxNumber: | 4107447593 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 W BALTIMORE ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212232245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103623000 | ||||||||
| FaxNumber: | 4103623647 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2007 | ||||||||
| LastUpdateDate: | 09/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | JOSEPH | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4103623000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0047529 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.