Provider Demographics
NPI:1386681609
Name:ODDO, JOSEPH R (PA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:R
Last Name:ODDO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:51 OVERBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8301
Mailing Address - Country:US
Mailing Address - Phone:716-836-4008
Mailing Address - Fax:
Practice Address - Street 1:2949 ELMWOOD AVE
Practice Address - Street 2:203
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1356
Practice Address - Country:US
Practice Address - Phone:716-447-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006442-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant