Provider Demographics
NPI:1538279955
Name:DWYER, JOEL P (CPO)
Entity type:Individual
Prefix:MR
First Name:JOEL
Middle Name:P
Last Name:DWYER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:45 WHITE CAP LANE
Mailing Address - City:WEST BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02668
Mailing Address - Country:US
Mailing Address - Phone:508-362-8329
Mailing Address - Fax:508-362-8329
Practice Address - Street 1:45 WHITE CAP LANE
Practice Address - Street 2:
Practice Address - City:WEST BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02668
Practice Address - Country:US
Practice Address - Phone:508-362-8329
Practice Address - Fax:508-362-8329
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA759527OtherTUFTS
MA1523538Medicaid
MA700149OtherHARVARD PILGRIM HEALTH
MA355754OtherBCBS
MA0125700001Medicare NSC