Individual
DR. CARLOS FERNANDEZ DELARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
122 12TH STREET EXT, PRINCETON, WV 24740-2352
(304) 487-7349
Mailing address
PO BOX 489, BLUEFIELD, WV 24701-0489
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
10126
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0104624000
—
WV
01
—
220033106
RAILROAD MEDICARE
—
Enumeration date
07/14/2005
Last updated
01/27/2009
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