Provider Demographics
NPI:1508826462
Name:FAMULARCANO, PRECILLA T (MD)
Entity Type:Individual
Prefix:
First Name:PRECILLA
Middle Name:T
Last Name:FAMULARCANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276
Mailing Address - Country:US
Mailing Address - Phone:304-927-5262
Mailing Address - Fax:304-927-0379
Practice Address - Street 1:141 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276
Practice Address - Country:US
Practice Address - Phone:304-927-5262
Practice Address - Fax:304-927-0379
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049951000Medicaid
WV0049951000Medicaid
WVFA7289331Medicare ID - Type Unspecified