Provider Demographics
NPI:1093805392
Name:ELLINGTON, JOE CAREY JR (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:CAREY
Last Name:ELLINGTON
Suffix:JR
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:613 PIGEON ROOST TRL
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-4247
Mailing Address - Country:US
Mailing Address - Phone:304-487-6526
Mailing Address - Fax:304-487-3914
Practice Address - Street 1:112 UNDERCLIFF TER
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2174
Practice Address - Country:US
Practice Address - Phone:304-425-3800
Practice Address - Fax:304-487-3914
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-15
Last Update Date:2007-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV20877207V00000X
VA0101232504207V00000X
NC9500564207V00000X
MI4301057671207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1812228-000Medicaid
VA6202021Medicaid
WV1812228-000Medicaid
VA6202021Medicaid