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Organization
MANUEL B. VILLANUEVA M.D., P.C.
Active
Organization
MANUEL B. VILLANUEVA M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANUEL B. VILLANUEVA M.D. (OWNER)
(304) 877-2600
Entity
Organization
Contact information
Practice address
6070 ROBERT C BYRD DR, BRADLEY, WV 25818
(304) 877-2600
(304) 877-2600
Mailing address
PO BOX 265, BRADLEY, WV 25818-0265
(304) 877-2600
(304) 877-2600
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11992
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0056004000
—
WV
01
—
410013738
RAILROAD MEDICARE
WV
Enumeration date
11/16/2007
Last updated
05/22/2008
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