Provider Demographics
NPI:1508808007
Name:RAGO, ANDRES LAURENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:LAURENTE
Last Name:RAGO
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:HC 52 BOX 135
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE
Mailing Address - State:WV
Mailing Address - Zip Code:24868-7501
Mailing Address - Country:US
Mailing Address - Phone:304-862-4611
Mailing Address - Fax:
Practice Address - Street 1:135 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KEYSTONE
Practice Address - State:WV
Practice Address - Zip Code:24868
Practice Address - Country:US
Practice Address - Phone:304-862-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0042438000Medicaid
WVD49339Medicare UPIN
WV0494704Medicare PIN