Provider Demographics
NPI:1669464004
Name:OTHMAN, JOE O (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:O
Last Name:OTHMAN
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:RR02 BOX 169
Mailing Address - Street 2:GREYROCK PROFESS. PARK
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-9316
Mailing Address - Country:US
Mailing Address - Phone:304-647-3040
Mailing Address - Fax:304-647-3835
Practice Address - Street 1:RR 2 BOX 169
Practice Address - Street 2:GREYROCK PROFESS. PARK
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9316
Practice Address - Country:US
Practice Address - Phone:304-647-3040
Practice Address - Fax:304-647-3835
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV154112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0089749000Medicaid
WV0089749000Medicaid
9268691Medicare ID - Type Unspecified