Provider Demographics
NPI:1114096161
Name:ANDRES L. RAGO MD PC
Entity Type:Organization
Organization Name:ANDRES L. RAGO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:L
Authorized Official - Last Name:RAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-862-4611
Mailing Address - Street 1:HC 52 BOX 135
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE
Mailing Address - State:WV
Mailing Address - Zip Code:24852-7501
Mailing Address - Country:US
Mailing Address - Phone:304-862-4611
Mailing Address - Fax:304-862-4611
Practice Address - Street 1:135 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KEYSTONE
Practice Address - State:WV
Practice Address - Zip Code:24852
Practice Address - Country:US
Practice Address - Phone:304-862-4611
Practice Address - Fax:304-862-4611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1300188OtherCAREMARK
WV0042438000Medicaid
WV0042438000Medicaid