Provider Demographics
NPI:1821037250
Name:CARANDANG, VIRGILIO C (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRGILIO
Middle Name:C
Last Name:CARANDANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VIRGIL
Other - Middle Name:C
Other - Last Name:CARANDANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1631 NORTH LOOP WEST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008
Mailing Address - Country:US
Mailing Address - Phone:713-864-7633
Mailing Address - Fax:
Practice Address - Street 1:1631 NORTH LOOP WEST
Practice Address - Street 2:SUITE 430
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008
Practice Address - Country:US
Practice Address - Phone:713-864-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0915207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0811551OtherAETNA
10017569OtherAMERIGROUP
TX140120008Medicaid
TX000000EE59OtherBLUE CROSS BLUE SHIELD
192108092836OtherHUMANA
751590503OtherFEDERAL TAX ID
0811551OtherAETNA
00EE59Medicare ID - Type Unspecified