Provider Demographics
NPI:1841227790
Name:LARES, NANCY BETH (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:BETH
Last Name:LARES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-9202
Mailing Address - Country:US
Mailing Address - Phone:304-675-1484
Mailing Address - Fax:304-675-1489
Practice Address - Street 1:2414 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-1528
Practice Address - Country:US
Practice Address - Phone:304-675-1484
Practice Address - Fax:304-675-1489
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22263207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV550737600OtherTAX IDENTIFICATION
WV550737600OtherTAX IDENTIFICATION