MEDICARE: RONALD JOSEPHSON MD

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	207RG0100X	Gastroenterology Physician	017084	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010017084CT01	OTHER	CT	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639156250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD JOSEPHSON MD

Provider Business Mailing Address
First Line	:	30 JORDAN LN
Second Line	:	PRIME HEALTHCARE
City	:	WETHERSFIELD
State	:	CT
Zip	:	06109-1278
Country	:	US
Telephone Number	:	860-263-0253
Fax Number	:	860-263-0262

Provider Business Practice Location Address
First Line	:	44 DALE RD
Second Line	:	PRIME HEALTHCARE
City	:	AVON
State	:	CT
Zip	:	06001-3612
Country	:	US
Telephone Number	:	860-674-8830
Fax Number	:	860-674-8984

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

Provider Enumeration Date	:	12/23/2005
Last Update Date	:	11/03/2009

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