Provider Demographics
NPI:1851514830
Name:WEST VIRGINIA GYNECOLOGIC ONCOLOGY ASSOC LLC
Entity Type:Organization
Organization Name:WEST VIRGINIA GYNECOLOGIC ONCOLOGY ASSOC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-925-4200
Mailing Address - Street 1:1 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-2696
Mailing Address - Country:US
Mailing Address - Phone:304-925-4200
Mailing Address - Fax:
Practice Address - Street 1:1 COURTNEY DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-2696
Practice Address - Country:US
Practice Address - Phone:304-925-4200
Practice Address - Fax:304-925-0484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18239207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0078182000Medicaid
WV18239OtherSTATE LICENSE
WV9342791Medicare ID - Type Unspecified
WV0078182000Medicaid