Provider Demographics
NPI:1558177857
Name:GUIDRY, JOSEPH III (MD)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:GUIDRY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOSEPH
Other - Middle Name:
Other - Last Name:GUIDRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4101 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1143
Mailing Address - Country:US
Mailing Address - Phone:894-205-0047
Mailing Address - Fax:
Practice Address - Street 1:4101 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1143
Practice Address - Country:US
Practice Address - Phone:894-205-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB64205834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical