Provider Demographics
NPI:1568494029
Name:JOSEPH, NICOL E (DO)
Entity type:Individual
Prefix:
First Name:NICOL
Middle Name:E
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4190 CITY AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1626
Mailing Address - Country:US
Mailing Address - Phone:215-871-6844
Mailing Address - Fax:215-871-6932
Practice Address - Street 1:4190 CITY AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-1626
Practice Address - Country:US
Practice Address - Phone:215-871-6844
Practice Address - Fax:215-871-6932
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS013738207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101695926Medicaid
PAI63108Medicare UPIN
PA101695926Medicaid