Provider Demographics
NPI:1578626529
Name:ROSAS-ACEVEDO, ANGEL L (MD)
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:L
Last Name:ROSAS-ACEVEDO
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 1:252 RURAL ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3503
Mailing Address - Country:US
Mailing Address - Phone:304-253-2628
Mailing Address - Fax:304-252-1790
Practice Address - Street 1:410 CARRIAGE DR
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2806
Practice Address - Country:US
Practice Address - Phone:304-255-1541
Practice Address - Fax:304-253-7067
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16668207V00000X, 2085U0001X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV55855Medicaid
WV2107367OtherUNITED HEALTH CARE
WV1718524OtherBLUE CROSS BLUE SHIELD
WV70987Medicaid
WV0092037000Medicaid
WV0092037000Medicaid
WVRO2026427Medicare PIN
WV1718524OtherBLUE CROSS BLUE SHIELD
WVRO2026428Medicare PIN