Provider Demographics
NPI:1205063906
Name:MORRELLO, JOSEPH WAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WAYNE
Last Name:MORRELLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3997 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-7660
Mailing Address - Country:US
Mailing Address - Phone:304-431-5499
Mailing Address - Fax:304-431-3400
Practice Address - Street 1:3997 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-7660
Practice Address - Country:US
Practice Address - Phone:304-431-5499
Practice Address - Fax:304-431-3400
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203044207R00000X
WV2618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024973Medicaid