Provider Demographics
NPI:1962401281
Name:NEDRESKY, JOSEPH PETER (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PETER
Last Name:NEDRESKY
Suffix:
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 1:201 STATE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16550-0002
Mailing Address - Country:US
Mailing Address - Phone:814-877-6182
Mailing Address - Fax:814-877-6149
Practice Address - Street 1:201 STATE ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16550-0002
Practice Address - Country:US
Practice Address - Phone:814-877-6182
Practice Address - Fax:814-877-6149
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030570E2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1068775OtherWEST VIRGINIA WORK COMP
PA147557OtherUNISON - HAMOT RADIOLOGY
PA089742OtherUNISON - IMAGING CENTER
NY00025763001OtherUNIVERA
OH864953OtherOH MEDICAL ASSISTANCE
PA1509348OtherGATEWAY
PA300107129OtherRR MEDICARE
PA302903OtherUPMC
PA0012584180008Medicaid
NY01613450OtherNY MEDICAL ASSISTANCE
PA153688OtherBLUE SHIELD
PA3341496OtherAETNA
PA153688OtherBLUE SHIELD
PA302903OtherUPMC