Provider Demographics
NPI:1821198144
Name:LONCAREVICH, JOSEPH (PA)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:LONCAREVICH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:HETTINGER
Mailing Address - State:ND
Mailing Address - Zip Code:58639-7530
Mailing Address - Country:US
Mailing Address - Phone:701-567-4561
Mailing Address - Fax:701-567-6361
Practice Address - Street 1:401 6TH AVE W
Practice Address - Street 2:
Practice Address - City:LEMMON
Practice Address - State:SD
Practice Address - Zip Code:57638-1318
Practice Address - Country:US
Practice Address - Phone:605-374-3773
Practice Address - Fax:605-374-3425
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0093363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19919OtherBLUE CROSS OF NORTH DAKOT
SD7829Medicare ID - Type Unspecified
ND19919OtherBLUE CROSS OF NORTH DAKOT