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General NPI Number Information
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NPI Number | 1326223819
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Entity Type | Organization
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Legal Business Name | JOY E COUSINS D O CO
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Dates
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Enumeration Date | 01/03/2008
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Last Update Date | 01/10/2008
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Provider Practice Location Address
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Address Line | 1 GRAND CENTRAL PARK SUITE 2060
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City | KEYSER
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State | WV
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Zip | 26726-3157
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Country | US
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Telephone | 304-788-2280
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Fax |
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Provider Business Mailing Address
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Address Line | 1 GRAND CENTRAL PARK SUITE 2060
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City | KEYSER
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State | WV
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Zip | 26726-3157
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Country | US
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Telephone | 304-788-2280
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | JOY E COUSINS
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Credential | DO
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Telephone | 304-788-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1809
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License Number State | WV
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