Provider Demographics
NPI:1194807800
Name:CHILD, JOSIAH H (MD)
Entity type:Individual
Prefix:
First Name:JOSIAH
Middle Name:H
Last Name:CHILD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HOSPITAL DR STE 500
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4794
Mailing Address - Country:US
Mailing Address - Phone:505-603-5324
Mailing Address - Fax:505-983-7571
Practice Address - Street 1:1650 HOSPITAL DR STE 500
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4794
Practice Address - Country:US
Practice Address - Phone:505-603-5324
Practice Address - Fax:505-983-7571
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0791207P00000X, 207R00000X
CT041145207P00000X
CAC155374207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H97170Medicare UPIN