Provider Demographics
NPI:1023234879
Name:AYOOB, ROSE MARY (MD)
Entity type:Individual
Prefix:DR
First Name:ROSE
Middle Name:MARY
Last Name:AYOOB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MEDICAL CENTER DR STE 3500
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3655
Mailing Address - Country:US
Mailing Address - Phone:304-691-1300
Mailing Address - Fax:
Practice Address - Street 1:1600 MEDICAL CENTER DR STE 3500
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3655
Practice Address - Country:US
Practice Address - Phone:304-691-1300
Practice Address - Fax:304-691-1375
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23626208000000X, 2080P0210X
OH35-0936712080P0204X
OH350936712080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061138Medicaid