Ramon Lacanilao, MD
Individual provider Active NPI Pediatrics Physician · Beckley, WV
NPI 1124133228 · NPPES record last updated Jan 28, 2010
Key facts
- NPI
- 1124133228
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 22204 (WV)
- Practice address
- 30 Mallard Court
Beckley, WV 25801-3140 - Phone
- (304) 255-0800
- Fax
- (304) 255-1040
- NPI assigned
- Aug 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22204 | WV | MD | Otolaryngology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 22204 | WV | Yes |
Addresses
Primary practice location
30 Mallard Court
Beckley, WV 25801-3140
Mailing address
30 Mallard Court
Beckley, WV 25801-3140
Phone (304) 255-0800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2160452 | Other | WV | UHC |
| 3792827 | Other | WV | CIGNA |
| 3810007472 | Medicaid | WV | |
| 1902692 | Other | WV | MTN ST BCBS |
| 10383200 | Medicaid | VA | |
| 7374822 | Other | WV | AETNA |
Other providers in Beckley, WV
- Kathryn Kutil
- Tinashe Blessings Kwenda
- Ronald Lee Kyer
- Kyle Group PLLC
- L.C. Maramba, M.D., Inc.
- William Christopher Lacost
- Beverly Lynn Lafferty
- Christie Michelle Lafferty
- Emilee Dawn Lafferty
- Jennifer N Lambert
All providers in Beckley, WV · Pediatrics Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.