Provider Demographics
NPI:1316923360
Name:JORIZZO, JOSEPH LUCIUS (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LUCIUS
Last Name:JORIZZO
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:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0344
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-9258
Practice Address - Street 1:4618 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-3520
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-9258
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-21
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245561207N00000X
NC21054207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2714OtherPARTNERS
4228691OtherAETNA
NC8947508Medicaid
NC47508OtherBCBS
NC63999OtherMEDCOST
WV2000696000Medicaid
VA5906661Medicaid
SCQ21054Medicaid
C84794Medicare UPIN
VA5906661Medicaid