JOEDY L DARISTOTLE (NPI# 1780712752) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780712752 |
| Entity Type | Individual |
| Full Name | JOEDY L DARISTOTLE |
| Credential | M.D. |
| Practice Address |
1712 Locust Ave Fairmont WV 26554-1321 |
| Practice Telephone | 3043666157 |
| Practice Fax Number | 3043660177 |
| Mailing Telephone | 3043666157 |
| Mailing Fax Number | 3043660177 |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-10-16 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0602X |
Otolaryngology Specialization: Otolaryngic Allergy |
WV14772 | WV | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WV | 0041418000 | 05 |
| Street Address |
1712 LOCUST AVE |
| City | FAIRMONT |
| State | WV |
| Zip Code | 26554-1321 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720055882 | Fairmont Ent Associates Inc | Hearing Aid Equipment | 1712 Locust Ave, Fairmont, WV 26554 | 2006-03-07 |
| 1922307065 | Catherine D Ingle | Audiologist | 1712 Locust Ave, Fairmont, WV 26554-1321 | 2011-03-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801497680 | Vanquisha Clay | Technician | 118 Conaway St, Fairmont, WV 26554 | 2020-11-06 |
| 1851903363 | Denise S Greer | Technician | 1029 Prickett Road, Fairmont, WV 26554 | 2020-08-18 |
| 1730790775 | Darla Lee Mcrobie | Technician | 105 C'anna Square, Fairmont, WV 26554 | 2020-08-13 |
| 1376025718 | Jason Batten | Counselor | 621 Maryland Ave, Fairmont, WV 26554 | 2018-09-02 |
| 1437669066 | Ultimate Health & Wellness, LLC | Naturopath | 2862 Whitehall Blvd, Whitehall, WV 26554 | 2017-10-10 |
| 1457872376 | Michele R Lilley | Nurse Practitioner | 177 Middletown Rd, Ste1, Upc Whitehall Medical, Fairmont, WV 26554 | 2017-06-30 |
| 1477906154 | Rebecca Hayes-merrill | Counselor | 212 Adams St., 3rd Floor, Fairmont, WV 26554 | 2016-07-19 |
| 1790173417 | Dennis Michael Lynch | Counselor | 5 Turf Lane, Fairmont, WV 26554 | 2015-01-05 |
| 1336558725 | Nicole Savage | Home Health Aide | 122 Abbott St, Fairmont, WV 26554 | 2014-08-11 |
| 1124434550 | Achuta Ram Aynampudi | Psychiatry & Neurology | 100 Stoney Hill Rd, Fairmont, WV 26554 | 2014-07-07 |
| Find all providers in zip 26554 | ||||
| Taxonomy Code | 207YX0602X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otolaryngic Allergy |
| An otolaryngologist who specializes in the diagnosis and treatment of otolaryngic allergies and other allergic diseases. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457395808 | Charles Abraham | Otolaryngology | 1231 6th Ave, Huntington, WV 25701-2311 | 2006-06-16 |
| 1477899623 | Ear, Nose & Throat Physicians and Surgeons of Charleston, Pllc | Otolaryngology | 4408 Maccorkle Ave Se, Charleston, WV 25304-2506 | 2012-12-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.