Provider Demographics
NPI:1760482269
Name:COLELLA, JOSEPH JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JAMES
Last Name:COLELLA
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 1:101 MEDICAL PARK
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-6530
Mailing Address - Fax:304-243-8802
Practice Address - Street 1:101 MEDICAL PARK
Practice Address - Street 2:SUITE 101
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-6530
Practice Address - Fax:304-243-8802
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.127073208600000X
WV29314208600000X
PAMD040420E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821847Medicaid
WV0045152000Medicaid
PA0012445200009Medicaid
PA664445NHKMedicare PIN
WV0045152000Medicaid
PAE79573Medicare UPIN
PA0012445200009Medicaid
OHH433890Medicare PIN
PA020044320Medicare PIN