Provider Demographics
NPI:1528218435
Name:GUIMARAES NUNES ROSADO, FLAVIA (MD)
Entity Type:Individual
Prefix:DR
First Name:FLAVIA
Middle Name:
Last Name:GUIMARAES NUNES ROSADO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FLAVIA
Other - Middle Name:GUIMARAES
Other - Last Name:NUNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 STADIUM DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-7900
Mailing Address - Country:US
Mailing Address - Phone:304-293-3214
Mailing Address - Fax:
Practice Address - Street 1:1 STADIUM DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-7900
Practice Address - Country:US
Practice Address - Phone:304-293-3214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54981207ZP0105X
WV25768207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN220001605Medicare PIN