Basic Information
| Provider Information | |||||||||
| NPI: | 1962471003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOSEPHS | ||||||||
| FirstName: | LEON | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 630 PLANTATION ST | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016052038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683190 | ||||||||
| FaxNumber: | 5083683193 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 SUMMER ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016081216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083683190 | ||||||||
| FaxNumber: | 5083683193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 56820 | MA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 042472266 | 01 | HEALTHCARE VALUE MGMT | OTHER | 042472266 | 01 | PRIVATE HEALTHCARE SYSTEM | OTHER | J06987 | 01 | BLUE SHIELD INDEMNITY | OTHER | 2044702 | 01 | FIRST HEALTH | OTHER | 5060175 | 01 | AETNA US HEALTCARE | OTHER | J06987 | 01 | BLUE SHIELD HMO BLUE | OTHER | AA5965 | 01 | HARVARD PILGRIM HEALTHCAR | OTHER | 042472266 | 01 | ONE HEALTH PLAN | OTHER | 2900343 | 01 | EVERCARE | OTHER | 3030351 | 01 | MEDICAID WELFARE | OTHER | J06987 | 01 | BLUE CARE ELECT | OTHER | 5068965 | 01 | CIGNA HEALTH PLAN | OTHER | J06987 | 01 | MEDICARE B | OTHER | 3030351 | 01 | HEALTHY START | OTHER | 3030351 | 05 | MA | MEDICAID | 33794 | 01 | FALLON COMMUNITY HEALTH P | OTHER | 784032 | 01 | MVP HEALTH CARE | OTHER | 784033 | 01 | MVP HEALTH CARE | OTHER |