Provider Demographics
NPI:1134221153
Name:DELA ROSA, ROMULO GANUELAS (MD)
Entity type:Individual
Prefix:MR
First Name:ROMULO
Middle Name:GANUELAS
Last Name:DELA ROSA
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:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-0007
Mailing Address - Country:US
Mailing Address - Phone:304-938-2955
Mailing Address - Fax:304-938-2955
Practice Address - Street 1:26 MAIN STREET
Practice Address - Street 2:
Practice Address - City:IAEGER
Practice Address - State:WV
Practice Address - Zip Code:24844
Practice Address - Country:US
Practice Address - Phone:304-938-2955
Practice Address - Fax:304-938-2955
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14275207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5615330Medicaid
WV14275OtherLIC WV
WV14275OtherLIC WV
D49408Medicare UPIN
BD2414706OtherDEA