Provider Demographics
NPI:1942249826
Name:GUNNLAUGSSON, SKULI TOMAS (MD)
Entity Type:Individual
Prefix:
First Name:SKULI
Middle Name:TOMAS
Last Name:GUNNLAUGSSON
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 1:5170 US RT 60 EAST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705
Mailing Address - Country:US
Mailing Address - Phone:304-697-6000
Mailing Address - Fax:304-399-2280
Practice Address - Street 1:5170 US RT 60 EAST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705
Practice Address - Country:US
Practice Address - Phone:304-697-6000
Practice Address - Fax:304-399-2280
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21974207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002986Medicaid
KY64102767Medicaid
OH2590405Medicaid
P00237358OtherRAILROAD MEDICARE
KY64102767Medicaid
WV3810002986Medicaid