Individual
DR. MANUEL C VALLEJO JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD,DMD
Contact information
Practice address
1322 PINEVIEW DR, MORGANTOWN, WV 26505-0710
(304) 598-3100
Mailing address
1322 PINEVIEW DR, MORGANTOWN, WV 26505-0710
(304) 598-3100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
DS025489L
PA
207L00000X
Anesthesiology Physician
Primary
25529
WV
207L00000X
Anesthesiology Physician
MD058203L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001600607
—
PA
Enumeration date
02/24/2006
Last updated
07/21/2022
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