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Organization
CARLOS E LUCERO
Active
Organization
CARLOS E LUCERO
Active
Other names
Beckley Neonatal-Pediatric Care
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS ESTANISLAO LUCERO MD (OWNER)
(304) 255-7456
Entity
Organization
Contact information
Practice address
403 CARRIAGE DR, BECKLEY, WV 25801-2805
(304) 255-7456
(304) 255-5899
Mailing address
403 CARRIAGE DR, BECKLEY, WV 25801
(304) 255-7456
(304) 255-5899
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
10355
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112021000
—
WV
01
—
3810002253
MEDICAID GROUP
WV
05
—
3810002253
—
WV
Enumeration date
03/15/2007
Last updated
08/12/2008
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