Healthcare Provider Details

I. General information

NPI: 1245380831
Provider Name (Legal Business Name): JOSEPH J DEPETRO III MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 8TH ST
WELLSBURG WV
26070-1605
US

IV. Provider business mailing address

PO BOX 6691
WHEELING WV
26003-0913
US

V. Phone/Fax

Practice location:
  • Phone: 304-737-0321
  • Fax: 304-737-2979
Mailing address:
  • Phone: 304-233-2455
  • Fax: 304-233-6073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH J DEPETRO III
Title or Position: PRESIDENT
Credential: MD
Phone: 304-737-0321