Provider Demographics
NPI:1851395834
Name:VIGO PAREDES, TOMAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMAS
Middle Name:E
Last Name:VIGO PAREDES
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 1:132 GILCHRIST AVE
Mailing Address - Street 2:
Mailing Address - City:TORNADO
Mailing Address - State:WV
Mailing Address - Zip Code:25202-9640
Mailing Address - Country:US
Mailing Address - Phone:304-687-0054
Mailing Address - Fax:304-855-2245
Practice Address - Street 1:40 SHAE AVE
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-9805
Practice Address - Country:US
Practice Address - Phone:304-855-2211
Practice Address - Fax:304-855-2213
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-08
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17682207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV17682OtherWV MEDICAL LICENSE