Provider Demographics
NPI:1215038401
Name:TAYENGCO, ROBERT G (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:TAYENGCO
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:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:PT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550-0236
Mailing Address - Country:US
Mailing Address - Phone:304-675-1020
Mailing Address - Fax:304-675-5893
Practice Address - Street 1:2007 SECOND STREET
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:WV
Practice Address - Zip Code:25260
Practice Address - Country:US
Practice Address - Phone:304-773-5195
Practice Address - Fax:304-675-5167
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19087207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA000026375OtherBCBS
WV550737600OtherCOMMERICAL INSURANCE
WV0080756000Medicaid
OH2028755Medicaid
WV230077OtherFEDERAL BLACK LUNG
OH2028755Medicaid
WVTA0849721Medicare PIN