Provider Demographics
NPI:1699763516
Name:ASIAF, JOSEPH RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RICHARD
Last Name:ASIAF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 OAK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1341
Mailing Address - Country:US
Mailing Address - Phone:508-584-1234
Mailing Address - Fax:508-584-0230
Practice Address - Street 1:370 OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1341
Practice Address - Country:US
Practice Address - Phone:508-584-1234
Practice Address - Fax:508-584-0230
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28516208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0135151Medicaid
MA0135151Medicaid