Provider Demographics
NPI:1992012728
Name:IGNACIO H LUNA MD INC
Entity Type:Organization
Organization Name:IGNACIO H LUNA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IGNACIO
Authorized Official - Middle Name:HOELZL
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:304-845-6400
Mailing Address - Street 1:426 EIGHTH ST.
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038
Mailing Address - Country:US
Mailing Address - Phone:304-845-6400
Mailing Address - Fax:304-845-3852
Practice Address - Street 1:426 EIGHTH ST.
Practice Address - Street 2:SUITE 300
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038
Practice Address - Country:US
Practice Address - Phone:304-845-6400
Practice Address - Fax:304-845-3852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-31
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.100261208800000X
WV10356208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0210917Medicaid
WV0130878000Medicaid
OH0210917Medicaid
OH8801064Medicare PIN
WV0130878000Medicaid