Provider Demographics
NPI:1720119597
Name:ROBERT L. JOSEPH, MD, INC
Entity Type:Organization
Organization Name:ROBERT L. JOSEPH, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:J
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-232-8440
Mailing Address - Street 1:1300 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3353
Mailing Address - Country:US
Mailing Address - Phone:304-232-8440
Mailing Address - Fax:304-232-6928
Practice Address - Street 1:1300 MARKET ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3353
Practice Address - Country:US
Practice Address - Phone:304-232-8440
Practice Address - Fax:304-232-6928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095927000Medicaid
OH0450631Medicaid
WV0401881Medicare ID - Type Unspecified
WV0095927000Medicaid