Healthcare Provider Details

I. General information

NPI: 1104809581
Provider Name (Legal Business Name): NANCY L JOSEPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE MEDICAL CENTER DRIVE
CLARKSBURG WV
26301
US

IV. Provider business mailing address

2042 LAUREL PARK RD
CLARKSBURG WV
26301-6980
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax:
Mailing address:
  • Phone: 304-623-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14712
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: