Healthcare Provider Details

I. General information

NPI: 1629686563
Provider Name (Legal Business Name): DORINE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7060 FOX GLOVE LN
HANOVER MD
21076-2439
US

IV. Provider business mailing address

7060 FOX GLOVE LN
HANOVER MD
21076-2439
US

V. Phone/Fax

Practice location:
  • Phone: 96-742-6462
  • Fax:
Mailing address:
  • Phone: 96-742-6462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR246082
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR246082
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP2000487
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: