Individual
CARLOS ESTANISLAO LUCERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
403 CARRIAGE DRIVE, BECKLEY, WV 25801
(304) 255-7456
(304) 255-5899
Mailing address
403 CARRIAGE DR, BECKLEY, WV 25801-2805
(304) 255-7456
(304) 255-5899
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
10355
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0112021000
—
WV
Enumeration date
05/23/2006
Last updated
07/07/2008
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