Provider Demographics
NPI:1184738288
Name:JOSEPH, BRIDGET (MD)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 BLACKWELL RD
Mailing Address - Street 2:STE 305
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2639
Mailing Address - Country:US
Mailing Address - Phone:540-428-1715
Mailing Address - Fax:540-428-1716
Practice Address - Street 1:493 BLACKWELL RD
Practice Address - Street 2:STE 305
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2639
Practice Address - Country:US
Practice Address - Phone:540-428-1715
Practice Address - Fax:540-428-1716
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249683207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184738288Medicaid
WV0074854000Medicaid
WVJO0833121Medicare ID - Type UnspecifiedRIPLEY, WV OFFICE
WVJO8805993Medicare ID - Type UnspecifiedPARKERSBURG, WV OFFICE
WVJO8805991Medicare ID - Type UnspecifiedCHARLESTON, WV OFFICE
VA1184738288Medicaid
F40137Medicare UPIN
WVJO0833123Medicare ID - Type UnspecifiedLOGAN, WV OFFICE
WV0074854000Medicaid