Provider Demographics
NPI:1366325557
Name:SUTPHIN, JOSHUA T
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:T
Last Name:SUTPHIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 EASTRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FORT ASHBY
Mailing Address - State:WV
Mailing Address - Zip Code:26719-6924
Mailing Address - Country:US
Mailing Address - Phone:304-790-3988
Mailing Address - Fax:
Practice Address - Street 1:162 EASTRIDGE LN
Practice Address - Street 2:
Practice Address - City:FORT ASHBY
Practice Address - State:WV
Practice Address - Zip Code:26719-6924
Practice Address - Country:US
Practice Address - Phone:304-790-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV528921146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic