Healthcare Provider Details

I. General information

NPI: 1043209042
Provider Name (Legal Business Name): JEFFREY ALBIN VOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE BOX 9203
MORGANTOWN WV
26506-9203
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE BOX 9203
MORGANTOWN WV
26506-9203
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-3212
  • Fax: 304-293-1627
Mailing address:
  • Phone: 304-293-3212
  • Fax: 304-293-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number23275
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number40604-020
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number10897
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number70848
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: