Provider Demographics
NPI:1225109002
Name:DUREMDES, GENEROSO D (MD)
Entity Type:Individual
Prefix:
First Name:GENEROSO
Middle Name:D
Last Name:DUREMDES
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 1374
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1374
Mailing Address - Country:US
Mailing Address - Phone:304-425-5093
Mailing Address - Fax:304-487-3675
Practice Address - Street 1:100 NEW HOPE RD STE 106
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2143
Practice Address - Country:US
Practice Address - Phone:304-425-5093
Practice Address - Fax:304-487-3675
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09778208600000X
VA0101022907208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7335067Medicaid
WV0127426000Medicaid
VA7335067Medicaid
WV0161552Medicare PIN