Provider Demographics
NPI:1669511135
Name:HENRY P. GOSIENE,M.D.,P.C.
Entity Type:Organization
Organization Name:HENRY P. GOSIENE,M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GOSIENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-252-4216
Mailing Address - Street 1:22 MALLARD CT
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3615
Mailing Address - Country:US
Mailing Address - Phone:304-252-4216
Mailing Address - Fax:304-253-6809
Practice Address - Street 1:22 MALLARD CT
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3615
Practice Address - Country:US
Practice Address - Phone:304-252-4216
Practice Address - Fax:304-253-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00603207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1043213762OtherNPI HENRY P GOSIENE M.D.
9188541OtherMEDICARE ID
1437241346OtherTAOUFIK SADAT M.D. , NPI
CJ9809OtherRAILROAD MEDICARE
WV0095654001Medicaid
WV0240042000Medicaid
0425002OtherMEDICARE ID
9188541Medicare PIN
1043213762OtherNPI HENRY P GOSIENE M.D.
WV0240042000Medicaid
WV0095654001Medicaid