Provider Demographics
NPI:1982710786
Name:JOSEPH, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3353
Mailing Address - Country:US
Mailing Address - Phone:304-232-8440
Mailing Address - Fax:304-232-6928
Practice Address - Street 1:1300 MARKET ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3353
Practice Address - Country:US
Practice Address - Phone:304-232-8440
Practice Address - Fax:304-232-6928
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV9134207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095927000Medicaid
OH0450631OtherOHIO MEDICAID
WV0401881Medicare ID - Type Unspecified
OH0450631OtherOHIO MEDICAID
WV0434820001Medicare NSC