Provider Demographics
NPI:1427040419
Name:GOLDEN, JOSEPH IVAN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:IVAN
Last Name:GOLDEN
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 1:497 MALL RD
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-6216
Mailing Address - Country:US
Mailing Address - Phone:304-469-2905
Mailing Address - Fax:304-465-5486
Practice Address - Street 1:497 MALL RD
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-6216
Practice Address - Country:US
Practice Address - Phone:304-469-2905
Practice Address - Fax:304-465-5486
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0056901000Medicaid
WV2028932Medicare PIN
WV2028933Medicare PIN
WVWV0091BMedicare PIN
WV2028931Medicare PIN
WV0056901000Medicaid
A72169Medicare UPIN
WV2028934Medicare PIN