Provider Demographics
NPI:1497778427
Name:AGBAYANI, ERNESTO H (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:H
Last Name:AGBAYANI
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 1:155 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1807372000Medicaid
WV1807372000Medicaid
WV0889892Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID