Provider Demographics
NPI:1447218458
Name:MACATANGAY, SERGIO CAPUNO (MD)
Entity Type:Individual
Prefix:MR
First Name:SERGIO
Middle Name:CAPUNO
Last Name:MACATANGAY
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 250
Mailing Address - Street 2:11710 MAIN ST
Mailing Address - City:WAR
Mailing Address - State:WV
Mailing Address - Zip Code:24892-0250
Mailing Address - Country:US
Mailing Address - Phone:304-875-2299
Mailing Address - Fax:304-875-2205
Practice Address - Street 1:11710 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAR
Practice Address - State:WV
Practice Address - Zip Code:24892-0250
Practice Address - Country:US
Practice Address - Phone:304-875-2299
Practice Address - Fax:304-875-2205
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13158208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice