MEDICARE: JOSEPH LUCIUS JORIZZO MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	245561	NY
2	207N00000X	Dermatology Physician	21054	NC

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2714	OTHER	NC	PARTNERS
2	4228691	OTHER		AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	47508	OTHER	NC	BCBS
5	63999	OTHER	NC	MEDCOST
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1316923360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH LUCIUS JORIZZO MD

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-9258

Provider Business Practice Location Address
First Line	:	4618 COUNTRY CLUB RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27104-3520
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-716-9258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/02/2018

4610 COUNTRY CLUB RD
WINSTON SALEM, NC
27104-3520

Practice Phone: 336-716-8237
Practice Fax: