Basic Information
| Provider Information | |||||||||
| NPI: | 1124482666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KODIYAN | ||||||||
| FirstName: | JOYSON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 896158 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282896158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004514959 | ||||||||
| FaxNumber: | 6027733664 | ||||||||
| Practice Location | |||||||||
| Address1: | 3415 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881790 | ||||||||
| FaxNumber: | 3043881795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2016 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 30579 | WV | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.