Healthcare Provider Details

I. General information

NPI: 1659734358
Provider Name (Legal Business Name): SIJO V JOSEPH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E UNIVERSITY PKWY DEPT OF MEDICINE
BALTIMORE MD
21218-2829
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 410-554-2284
  • Fax: 410-554-2184
Mailing address:
  • Phone: 315-464-5189
  • Fax: 315-464-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberU9279
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number300786
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: