Basic Information
| Provider Information | |||||||||
| NPI: | 1477533768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEROSA | ||||||||
| FirstName: | JOSEPH | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2585 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257031642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046971396 | ||||||||
| FaxNumber: | 3046972086 | ||||||||
| Practice Location | |||||||||
| Address1: | 205 MARION PIKE | ||||||||
| Address2: | |||||||||
| City: | COAL GROVE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456383165 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405321188 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 09/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 1329 | WV | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 34004625 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 000000178447 | 01 | OH | ANTHEM BC | OTHER | 0715417 | 05 | OH | MEDICAID | 64698939 | 05 | KY | MEDICAID | 001709561 | 01 | OH | MT.STATE | OTHER | 0092290000 | 05 | WV | MEDICAID | 001790560 | 01 | WV | MT. STATE | OTHER |