Provider Demographics
NPI:1396767109
Name:JOSEPH D CONTI, MD, LLC
Entity type:Organization
Organization Name:JOSEPH D CONTI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-463-1046
Mailing Address - Street 1:119 PROFESSIONAL CENTER
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-463-1046
Mailing Address - Fax:724-463-2314
Practice Address - Street 1:119 PROFESSIONAL CENTER
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-463-1046
Practice Address - Fax:724-463-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012285100001Medicaid
PA086565Medicare ID - Type Unspecified