Provider Demographics
NPI:1699743344
Name:VALICENTI, JOSEPH F JR (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:F
Last Name:VALICENTI
Suffix:JR
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:PO BOX 60070
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-0070
Mailing Address - Country:US
Mailing Address - Phone:843-797-4179
Mailing Address - Fax:843-792-4296
Practice Address - Street 1:9330 MEDICAL PLAZA DRIVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-9195
Practice Address - Country:US
Practice Address - Phone:843-797-4179
Practice Address - Fax:843-797-4296
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6755207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC067554Medicaid
SC067554Medicaid