Provider Demographics
NPI:1982651121
Name:TAMPOYA, MANOLO D (MD)
Entity Type:Individual
Prefix:
First Name:MANOLO
Middle Name:D
Last Name:TAMPOYA
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 1:75 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3509
Mailing Address - Country:US
Mailing Address - Phone:304-235-2187
Mailing Address - Fax:304-235-2187
Practice Address - Street 1:75 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3509
Practice Address - Country:US
Practice Address - Phone:304-235-2187
Practice Address - Fax:304-235-2187
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13846207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0049610000Medicaid
WVTA0559782Medicare ID - Type Unspecified
WV0049610000Medicaid