Provider Demographics
NPI:1013105535
Name:MARIA LUNA TAN NAVARRO MD INC
Entity Type:Organization
Organization Name:MARIA LUNA TAN NAVARRO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-965-5888
Mailing Address - Street 1:PO BOX 193
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25321-0193
Mailing Address - Country:US
Mailing Address - Phone:304-965-5888
Mailing Address - Fax:304-965-3882
Practice Address - Street 1:# 5 ELK SHOPPING PLAZA
Practice Address - Street 2:
Practice Address - City:ELKVIEW
Practice Address - State:WV
Practice Address - Zip Code:25071
Practice Address - Country:US
Practice Address - Phone:304-965-5888
Practice Address - Fax:304-965-3882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
001719991OtherBCBS
D91205OtherCARELINK
2356236OtherUMWA 50 FUNDS
4387523OtherAETNA
D91205OtherCARELINK
4387523OtherAETNA