Provider Demographics
NPI:1134396484
Name:SINGZON, VICTORICO A (MD)
Entity type:Individual
Prefix:
First Name:VICTORICO
Middle Name:A
Last Name:SINGZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 MEDICAL PARK DR STE 500
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9010
Mailing Address - Country:US
Mailing Address - Phone:681-342-3660
Mailing Address - Fax:681-342-3625
Practice Address - Street 1:527 MEDICAL PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9010
Practice Address - Country:US
Practice Address - Phone:681-342-3660
Practice Address - Fax:681-342-3625
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV24530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020945Medicaid
WV3810020945Medicaid