Healthcare Provider Details

I. General information

NPI: 1023234879
Provider Name (Legal Business Name): ROSE MARY AYOOB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 12/21/2021
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR STE 3500
HUNTINGTON WV
25701-3655
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR STE 3500
HUNTINGTON WV
25701-3655
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1300
  • Fax: 304-691-1375
Mailing address:
  • Phone: 304-691-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23626
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number35-093671
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number35093671
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number23626
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: