MEDICARE: JOSEPH LAWRENCE MCDEVITT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	D0086317	MD

General Provider Information

NPI Number	:	1578952321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH LAWRENCE MCDEVITT

Provider Business Mailing Address
First Line	:	1405 POINT ST APT 810
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21231-3674
Country	:	US
Telephone Number	:	217-257-6687
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 N ORCHARD ST APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1576
Country	:	US
Telephone Number	:	217-257-6687
Fax Number	:

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

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	11/28/2019

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