Healthcare Provider Details

I. General information

NPI: 1538763446
Provider Name (Legal Business Name): JOAN MARIE GELDBAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N SPRING ST
BUCKHANNON WV
26201-2720
US

IV. Provider business mailing address

606 VILLAGE DR
FAIRMONT WV
26554-7976
US

V. Phone/Fax

Practice location:
  • Phone: 304-472-0395
  • Fax: 304-471-2488
Mailing address:
  • Phone: 702-412-2626
  • Fax: 304-471-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: