Individual
DR. FREDERICK MANALO ALCANTARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2048 VIP WAY, FAIRMONT, WV 26554
(304) 366-6200
(304) 366-4927
Mailing address
252 HANALEI DR, MORGANTOWN, WV 26508-4263
(304) 594-0916
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD432566
PA
207Q00000X
Family Medicine Physician
Primary
23746
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020032650001
—
PA
01
—
AL1983636
BLUE SHIELD
PA
01
—
P00434792
MEDICARE TRAVELERS
PA
Enumeration date
08/23/2007
Last updated
04/06/2022
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