Provider Demographics
NPI:1922063502
Name:NAEGELE, JAY T (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:T
Last Name:NAEGELE
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 1:5170 US ROUTE 60 E
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2065
Mailing Address - Country:US
Mailing Address - Phone:304-399-4422
Mailing Address - Fax:304-399-4433
Practice Address - Street 1:6007 ROUTE 60 EAST
Practice Address - Street 2:SUITE 203
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504
Practice Address - Country:US
Practice Address - Phone:304-733-9270
Practice Address - Fax:304-733-9087
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV20083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6700669000Medicaid
OH2178405Medicaid
KY64015936Medicaid
WV6700669000Medicaid
WV4022521Medicare ID - Type Unspecified