Provider Demographics
NPI:1043213762
Name:GOSIENE, HENRY P (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:P
Last Name:GOSIENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3615
Mailing Address - Country:US
Mailing Address - Phone:304-252-4216
Mailing Address - Fax:304-253-6809
Practice Address - Street 1:22 MALLARD CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3615
Practice Address - Country:US
Practice Address - Phone:304-252-4216
Practice Address - Fax:304-253-6809
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10945207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095654000Medicaid
D49246Medicare UPIN
0151950001Medicare NSC
CJ9809Medicare PIN
0425002Medicare PIN