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1790874063 NPI number — COLLEEN ANNE JOSEPH MD

NPI Number: 1790874063
Health Care Provider/Practitioner: COLLEEN ANNE JOSEPH MD

Information about “1790874063” NPI (COLLEEN ANNE JOSEPH MD) exists in 1790874063 in HTML format HTML  |  1790874063 in plain Text format TXT  |  1790874063 in PDF (Portable Document Format) PDF  |  1790874063 in an XML format XML  formats.

NPI Number : 1790874063 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790874063",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JOSEPH",
    "FirstName": "COLLEEN",
    "MiddleName": "ANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JOSEPH",
    "OtherFirstName": "COLLEEN",
    "OtherMiddleName": "ANNE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "2661 RIVA RD STE 1030",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ANNAPOLIS",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21401-7131",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-571-8733",
    "MailingAddressFaxNumber": "410-571-6309",
    "FirstLinePracticeLocationAddress": "6845 ELM ST STE 250",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MC LEAN",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22101-6048",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "703-356-5484",
    "PracticeLocationAddressFaxNumber": "703-356-2223",
    "EnumerationDate": "10/12/2006",
    "LastUpdateDate": "03/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "MD19696",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "D0043488",
          "LicenseNumberStateCode": "MD",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207W00000X",
          "TaxonomyName": "Ophthalmology Physician",
          "LicenseNumber": "0101048273",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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