Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 23626 | WV |
N | 2080P0204X | Pediatric Emergency Doctor | 35-093671 | OH |
Y | 2080P0210X | Pediatric Nephrologist | 23626 | WV |
N | 2080P0210X | Pediatric Nephrologist | 35093671 | OH |
NPI | 1023234879 |
---|---|
Provider Name | Dr. Rose Mary Ayoob |
First Address | Huntington, WV 25701-3655 |
Second Address | Huntington, WV 25701-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 21/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0061138 | (05) | OH |