Provider Demographics
NPI:1851329452
Name:JOSEPH P ENDRICH MD PLLC
Entity Type:Organization
Organization Name:JOSEPH P ENDRICH MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:P
Authorized Official - Last Name:ENDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-6061
Mailing Address - Street 1:PO BOX 2984
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-6984
Mailing Address - Country:US
Mailing Address - Phone:304-723-6061
Mailing Address - Fax:304-723-6063
Practice Address - Street 1:651 COLLIERS WAY
Practice Address - Street 2:SUITE 501
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5053
Practice Address - Country:US
Practice Address - Phone:304-723-6061
Practice Address - Fax:304-723-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV034265207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0201851000Medicaid
OH2437965Medicaid
WVJOSP00182Medicare ID - Type Unspecified
OH2437965Medicaid
WV0201851000Medicaid
WV9338541Medicare ID - Type Unspecified