Provider Demographics
NPI:1972617595
Name:ONGLATCO, JOHN DYBUNPIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DYBUNPIN
Last Name:ONGLATCO
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 1:324 NORTH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4038
Mailing Address - Country:US
Mailing Address - Phone:304-327-3408
Mailing Address - Fax:304-324-7967
Practice Address - Street 1:324 NORTH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4038
Practice Address - Country:US
Practice Address - Phone:304-327-3408
Practice Address - Fax:304-324-7967
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20634207L00000X
VA0101242167207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1000597000Medicaid
WV1000597000Medicaid
WVH54857Medicare UPIN