Individual
RAFAEL MODESTO RODIGHIERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
122 NICK SAVAS DR, LOGAN, WV 25601-3468
(304) 752-8081
(304) 752-8083
Mailing address
7400 LYNN AVE, HAMLIN, WV 25523-1138
(304) 824-5806
(304) 824-5804
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01624
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810022963
—
WV
Enumeration date
03/14/2012
Last updated
02/27/2013
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