# MANUEL B. VILLANUEVA M.D., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1457532632
- **Authorized official:** DR. MANUEL B. VILLANUEVA M.D. (OWNER)
- **Authorized official phone:** (304) 877-2600

## Contact information

- **Practice address:** 6070 ROBERT C BYRD DR, BRADLEY, WV 25818
- **Practice address phone:** (304) 877-2600
- **Practice address fax:** (304) 877-2600
- **Mailing address:** PO BOX 265, BRADLEY, WV 25818-0265
- **Mailing address phone:** (304) 877-2600
- **Mailing address fax:** (304) 877-2600

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 11992 | WV | Yes |

## Other

- **Enumeration date:** 11/16/2007
- **Last updated:** 05/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0056004000 | — | WV |
| 01 | — | 410013738 | RAILROAD MEDICARE | WV |