Provider Demographics
NPI:1205885308
Name:DELTORO GORDINHO, ISABEL CRISTINA (MD)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:CRISTINA
Last Name:DELTORO GORDINHO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2962 ROBERT C. BYRD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801
Mailing Address - Country:US
Mailing Address - Phone:304-254-9022
Mailing Address - Fax:304-254-9024
Practice Address - Street 1:2962 ROBERT C. BYRD DRIVE
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801
Practice Address - Country:US
Practice Address - Phone:304-254-9022
Practice Address - Fax:304-254-9024
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056752207K00000X
WV20422207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005806437Medicaid
WV0070431000Medicaid
VA282724OtherBLUE CROSS BLUE SHIELD
WV000385736OtherBLUE CROSS BLUE SHIELD
VA370000960Medicare PIN
WV000385736OtherBLUE CROSS BLUE SHIELD
G65265Medicare UPIN
WV4096111Medicare PIN