Healthcare Provider Details

I. General information

NPI: 1245367929
Provider Name (Legal Business Name): JOBY JOSEPH,MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OAKWOOD RD SUITE 210
CHARLESTON WV
25314-2000
US

IV. Provider business mailing address

888 OAKWOOD RD SUITE 210
CHARLESTON WV
25314-2000
US

V. Phone/Fax

Practice location:
  • Phone: 304-205-5821
  • Fax:
Mailing address:
  • Phone: 304-205-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number15460
License Number StateWV

VIII. Authorized Official

Name: DR. JOBY JOSEPH
Title or Position: PRESIDENT
Credential: MD
Phone: 304-205-5821