Provider Demographics
NPI:1154301893
Name:JOSEPH, GARY (DO)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DARROW RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5021
Mailing Address - Country:US
Mailing Address - Phone:330-656-5911
Mailing Address - Fax:330-656-5901
Practice Address - Street 1:667 EASTLAND AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4503
Practice Address - Country:US
Practice Address - Phone:330-841-4000
Practice Address - Fax:330-656-5901
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-006110 J207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000162489OtherANTHEM
OH001671224-0003OtherPENNSYLVANIA MEDICAID
OH0216779Medicaid
OH000000381140OtherANTHEM
OH000000381220OtherANTHEM
OH001671224-0001OtherPENNSYLVANIA MEDICAID
OH000000349348OtherANTHEM
OH000000381808OtherANTHEM
OH000000383091OtherANTHEM
OH000000385522OtherANTHEM
OH0216779Medicaid
OH990006307Medicare PIN
OH930078069Medicare PIN
OH000000349348OtherANTHEM
G14352Medicare UPIN
OH000000162489OtherANTHEM
OH000000381808OtherANTHEM
OH001671224-0001OtherPENNSYLVANIA MEDICAID
OHJO0796574Medicare PIN
OHJO0796575Medicare PIN