Healthcare Provider Details

I. General information

NPI: 1104830314
Provider Name (Legal Business Name): SCOTT A JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 LANDMARK DR
BELLEVUE KY
41073-1393
US

IV. Provider business mailing address

8105 KUGLER MILL RD
CINCINNATI OH
45243-1326
US

V. Phone/Fax

Practice location:
  • Phone: 859-392-3840
  • Fax: 859-392-3841
Mailing address:
  • Phone: 513-936-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35078733
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: