Provider Demographics
NPI:1154339018
Name:SACKS, JOSEPH DAVID (DPM)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DAVID
Last Name:SACKS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16311
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210
Mailing Address - Country:US
Mailing Address - Phone:410-366-0022
Mailing Address - Fax:410-366-0322
Practice Address - Street 1:4717 FALLS ROAD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209
Practice Address - Country:US
Practice Address - Phone:410-366-0022
Practice Address - Fax:410-366-0322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1120213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD347108000Medicaid
MDT329Medicare ID - Type Unspecified
MD347108000Medicaid