Provider Demographics
NPI:1992239032
Name:COLOSIMO, JOSEPH LOUIS II (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LOUIS
Last Name:COLOSIMO
Suffix:II
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 1:75 FREEDOM PKWY STE C
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-4939
Mailing Address - Country:US
Mailing Address - Phone:984-215-3265
Mailing Address - Fax:919-545-0096
Practice Address - Street 1:75 FREEDOM PKWY STE C
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-4939
Practice Address - Country:US
Practice Address - Phone:984-215-3265
Practice Address - Fax:919-545-0096
Is Sole Proprietor?:No
Enumeration Date:2017-04-15
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2022-01047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program