Provider Demographics
NPI:1174510861
Name:FAGUNDO, RAMON H (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:H
Last Name:FAGUNDO
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 1:314 S WELLS ST
Mailing Address - Street 2:
Mailing Address - City:SISTERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26175-1098
Mailing Address - Country:US
Mailing Address - Phone:304-652-2399
Mailing Address - Fax:304-652-1448
Practice Address - Street 1:314 S WELLS ST
Practice Address - Street 2:
Practice Address - City:SISTERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26175-1098
Practice Address - Country:US
Practice Address - Phone:304-652-2399
Practice Address - Fax:304-652-1448
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12937207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0112606000Medicaid
C03594Medicare UPIN
WV0112606000Medicaid