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Individual

JOSIAH KENNETH LILLY III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD MS

Contact information

Practice address
4001 VIRGINIA AVE SE, CHARLESTON, WV 25304-1603
(304) 925-2922
(304) 926-8009
Mailing address
4001 VIRGINIA AVE SE, CHARLESTON, WV 25304-1603
(304) 925-2922
(304) 926-8009

Taxonomy

Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
11322
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0201994
WV
Enumeration date
04/14/2006
Last updated
10/24/2007
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