Healthcare Provider Details

I. General information

NPI: 1326734260
Provider Name (Legal Business Name): JOSHUA MEASE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 WALNUT STREET SUITE 620
PHILADELPHIA PA
19107-5005
US

IV. Provider business mailing address

1015 WALNUT STREET, SUITE 620 SUITE 620
PHILADELPHIA PA
19107-4306
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6864
  • Fax: 215-955-2878
Mailing address:
  • Phone: 215-955-6864
  • Fax: 215-955-2878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: