Healthcare Provider Details

I. General information

NPI: 1962471003
Provider Name (Legal Business Name): LEON G JOSEPHS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUMMER ST STE 210
WORCESTER MA
01608-1216
US

IV. Provider business mailing address

630 PLANTATION ST
WORCESTER MA
01605-2038
US

V. Phone/Fax

Practice location:
  • Phone: 508-368-3190
  • Fax: 508-368-3193
Mailing address:
  • Phone: 508-368-3190
  • Fax: 508-368-3193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number56820
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: