Provider Demographics
NPI:1447534094
Name:JOSEPH, ELAM H (MD)
Entity type:Individual
Prefix:MR
First Name:ELAM
Middle Name:H
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 1:7 MEYER PLACE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CT
Mailing Address - Zip Code:06878
Mailing Address - Country:US
Mailing Address - Phone:203-637-8585
Mailing Address - Fax:203-637-8585
Practice Address - Street 1:7 MEYER PLACE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CT
Practice Address - Zip Code:06878
Practice Address - Country:US
Practice Address - Phone:203-637-8585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8173207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10640Medicare UPIN
000003229Medicare PIN