Provider Demographics
NPI:1831190206
Name:DONZELLA, JOSEPH GUY (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:GUY
Last Name:DONZELLA
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 1:1315 MOUNT DE CHANTAL RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-6357
Mailing Address - Country:US
Mailing Address - Phone:304-243-7117
Mailing Address - Fax:
Practice Address - Street 1:1315 MOUNT DE CHANTAL RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6357
Practice Address - Country:US
Practice Address - Phone:304-243-7117
Practice Address - Fax:304-243-5470
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1841882000Medicaid
OH2413258Medicaid
WV55035705700OtherWV COMPENSATION
1898OtherHEALTH PLAN OF UPPER OH V
001718182OtherMOUNTAIN STATE BCBS
001718182OtherMOUNTAIN STATE BCBS
WV55035705700OtherWV COMPENSATION
H85075Medicare UPIN