Healthcare Provider Details

I. General information

NPI: 1326069238
Provider Name (Legal Business Name): ANSON J JOSEPH - PATUXENT NEPHROLOGY ASSOC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 STEEPLE CHASE DR SUITE #206
PRINCE FREDERICK MD
20678-4053
US

IV. Provider business mailing address

PO BOX 2424
PRINCE FREDERICK MD
20678-2424
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-2085
  • Fax: 410-535-0404
Mailing address:
  • Phone: 410-535-2985
  • Fax: 410-535-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberD56161
License Number StateMD

VIII. Authorized Official

Name: DR. ANSON JACOB JOSEPH
Title or Position: MD
Credential: MD
Phone: 410-535-2085