Provider Demographics
NPI:1215962238
Name:HUMMEL, JOSEPH JACOB (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JACOB
Last Name:HUMMEL
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 1:1009 BINKLEY CHAPEL CT
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-4244
Mailing Address - Country:US
Mailing Address - Phone:919-880-6649
Mailing Address - Fax:
Practice Address - Street 1:2460 CURTIS ELLIS DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2237
Practice Address - Country:US
Practice Address - Phone:252-443-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500923207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13924OtherBCBS PROVIDER NUMBER
NCPENDINGMedicaid
NCPENDINGMedicaid
NC7553650001Medicare NSC
NC13924OtherBCBS PROVIDER NUMBER