Provider Demographics
NPI:1053349985
Name:AUL, JEROME J JR (MD)
Entity type:Individual
Prefix:DR
First Name:JEROME
Middle Name:J
Last Name:AUL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 HUDSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5604
Mailing Address - Country:US
Mailing Address - Phone:410-726-0471
Mailing Address - Fax:
Practice Address - Street 1:2366 HUDSON HILL RD
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5604
Practice Address - Country:US
Practice Address - Phone:410-726-0471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063836207L00000X
WV23896207LP2900X, 207LA0401X, 207L00000X
WI3169207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2702338Medicaid
WV3810017364Medicaid
MD409872200Medicaid
OHP00847435OtherRR MEDICARE
OH4286902Medicare PIN
OH2702338Medicaid
MDH40382Medicare UPIN
WV3810017364Medicaid
MDKP95N629Medicare ID - Type Unspecified