Organization
FAIRMONT ENT ASSOCIATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOEDY L DARISTOTLE MD (PRESIDENT)
(304) 366-6157
Entity
Organization
Contact information
Practice address
1712 LOCUST AVE, FAIRMONT, WV 26554
(304) 366-6157
(304) 366-0177
Mailing address
1712 LOCUST AVE, FAIRMONT, WV 26554
(304) 366-6157
(304) 366-0177
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
WV14772
WV
332S00000X
Hearing Aid Equipment
398
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008704000
—
WV
Enumeration date
03/07/2006
Last updated
10/26/2012
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