Provider Demographics
NPI:1477576510
Name:TALARICO, JOSEPH ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:TALARICO
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 1:1331 E VICTOR RD
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-9306
Mailing Address - Country:US
Mailing Address - Phone:585-398-8363
Mailing Address - Fax:585-398-8362
Practice Address - Street 1:1331 E VICTOR RD
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9306
Practice Address - Country:US
Practice Address - Phone:585-398-8363
Practice Address - Fax:585-398-8362
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112033174400000X
OH35.092182208600000X
FLME109797208600000X
NY271501208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112033Medicaid
IL213215Medicare ID - Type Unspecified
IL036112033Medicaid