Provider Demographics
NPI:1679665863
Name:MAIOLO, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:MAIOLO
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 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-252-8551
Mailing Address - Fax:304-252-1790
Practice Address - Street 1:252 RURAL ACRES DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3503
Practice Address - Country:US
Practice Address - Phone:304-252-8551
Practice Address - Fax:304-252-1790
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV08937207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0077924000Medicaid
A71987OtherHEALTH NET
209506OtherCARELINK
2119803OtherUNITEDHEALTHCARE
WV55852Medicaid
WVA08937Medicaid
WVP00163173Medicare ID - Type UnspecifiedTRAVELERS MEDICARE
WV55852Medicaid
2119803OtherUNITEDHEALTHCARE
A71987Medicare UPIN