Provider Demographics
NPI:1780601591
Name:JOSIMOVICH, PETER W (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:W
Last Name:JOSIMOVICH
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 1:10 AMALIA DR
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2271
Mailing Address - Country:US
Mailing Address - Phone:304-473-2200
Mailing Address - Fax:304-473-2057
Practice Address - Street 1:10 AMALIA DR
Practice Address - Street 2:SUITE B-1
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2271
Practice Address - Country:US
Practice Address - Phone:304-473-2200
Practice Address - Fax:304-473-2057
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1619207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0047938000Medicaid
WV0047938000Medicaid
WVG62633Medicare UPIN