Provider Demographics
NPI:1093929424
Name:MANN, JOSALYN MARIE (DO)
Entity type:Individual
Prefix:
First Name:JOSALYN
Middle Name:MARIE
Last Name:MANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:686 SOUTH PIKE ST
Mailing Address - Street 2:STE A
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1043
Mailing Address - Country:US
Mailing Address - Phone:304-624-4655
Mailing Address - Fax:304-624-3918
Practice Address - Street 1:1511 JOHNSON AVE
Practice Address - Street 2:STE 104
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1016
Practice Address - Country:US
Practice Address - Phone:304-848-0702
Practice Address - Fax:304-848-0705
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2022-04-05
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Provider Licenses
StateLicense IDTaxonomies
OH58.001640207Q00000X
WV2239207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810009403Medicaid
WV3810009403Medicaid
WV4212381Medicare PIN