Provider Demographics
NPI:1407072663
Name:ERNESTO H AGBAYANI MD PLLC
Entity Type:Organization
Organization Name:ERNESTO H AGBAYANI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:H
Authorized Official - Last Name:AGBAYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-596-6911
Mailing Address - Street 1:155 HEALTH CARE LN
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-4008
Mailing Address - Country:US
Mailing Address - Phone:304-596-6911
Mailing Address - Fax:304-596-6913
Practice Address - Street 1:155 HEALTH CARE LN
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-4008
Practice Address - Country:US
Practice Address - Phone:304-596-6911
Practice Address - Fax:304-596-6913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19905261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807372000Medicaid
WV0889892Medicare ID - Type UnspecifiedMEDICARE
WV1807372000Medicaid