Individual
MANUAL A. CASANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 446-5709
(740) 446-5697
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 441-1934
(740) 446-5982
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
15247
WV
2085R0202X
Diagnostic Radiology Physician
Primary
35-04-1898
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000007167
ANTHEM BCBS
—
01
—
000000193267
UNISON MEDICAID
OH
01
—
001714053
MOUNTAIN STATE BCBS
—
05
—
0118150000
—
WV
01
—
0465296
MOLINA MEDICAID
OH
01
—
300028173
RR MEDICARE
—
Enumeration date
05/17/2006
Last updated
02/11/2010
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