Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 0101034461 | VA |
NPI | 1346332939 |
---|---|
Provider Name | Dr. Jacob T Joseph |
First Address | Fairfax, VA 22030-6914 |
Second Address | Fairfax, VA 22030-6914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B93325 | (02) |