Healthcare Provider Details

I. General information

NPI: 1295799245
Provider Name (Legal Business Name): JOBY JOSEPH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORRIS ST STE 300
CHARLESTON WV
25301-1853
US

IV. Provider business mailing address

415 MORRIS ST STE 300
CHARLESTON WV
25301-1853
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-6441
  • Fax: 304-388-6445
Mailing address:
  • Phone: 304-388-6441
  • Fax: 304-388-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number15460
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number15460
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: