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Organization

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

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MANUEL B. VILLANUEVA M.D. (OWNER)
(304) 877-2600
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11992
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0056004000
WV
01
410013738
RAILROAD MEDICARE
WV
Enumeration date
11/16/2007
Last updated
05/22/2008
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