Provider Demographics
NPI:1134195712
Name:JOSEPH, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 SHERMAN DR
Mailing Address - Street 2:SUITE 2203
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1043
Mailing Address - Country:US
Mailing Address - Phone:812-385-1788
Mailing Address - Fax:812-385-1787
Practice Address - Street 1:1808 SHERMAN DR
Practice Address - Street 2:SUITE 2203
Practice Address - City:PRINCETON
Practice Address - State:IN
Practice Address - Zip Code:47670-1043
Practice Address - Country:US
Practice Address - Phone:812-385-1788
Practice Address - Fax:812-385-1787
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3075174400000X
IN01061734207X00000X
IL03611898207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200872840Medicaid
AR412042043OtherTAX ID NUMBER
IN252250Medicare PIN
ARH53571Medicare UPIN
IN200872840Medicaid