Provider Demographics
NPI:1922189745
Name:LIRIO, APOLONIO E JR (MD)
Entity Type:Individual
Prefix:
First Name:APOLONIO
Middle Name:E
Last Name:LIRIO
Suffix:JR
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:PO BOX 1602
Mailing Address - Street 2:RT 16
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827
Mailing Address - Country:US
Mailing Address - Phone:304-253-8336
Mailing Address - Fax:304-253-8337
Practice Address - Street 1:RT 16 ROBERT C BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:CRAB ORCHARD
Practice Address - State:WV
Practice Address - Zip Code:25827
Practice Address - Country:US
Practice Address - Phone:304-253-8336
Practice Address - Fax:304-253-8337
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV12065208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130871000Medicaid
WVCR9336201Medicare ID - Type Unspecified
WV0130871000Medicaid