Provider Demographics
NPI:1598786253
Name:MAJESTRO, TONY C (MD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:C
Last Name:MAJESTRO
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 1:415 MORRIS STREET
Mailing Address - Street 2:STE 104
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-343-1399
Mailing Address - Fax:304-345-7824
Practice Address - Street 1:415 MORRIS STREET
Practice Address - Street 2:STE 104
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301
Practice Address - Country:US
Practice Address - Phone:304-343-1399
Practice Address - Fax:304-345-7824
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV08956207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0098852000Medicaid
0660720001OtherCIGNA GOVERNMENT SERVICES
WV2138102OtherUNITED HCARE
WV001717974OtherBCBS
0660720001OtherCIGNA GOVERNMENT SERVICES
WVMA0176771Medicare ID - Type Unspecified