Provider Demographics
NPI:1245264928
Name:CUNANAN, ROBERTO A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:A
Last Name:CUNANAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1112
Mailing Address - Street 2:1322 LOCUST AVE
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-366-0700
Mailing Address - Fax:304-366-9529
Practice Address - Street 1:1322 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-366-0700
Practice Address - Fax:304-366-9529
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV109372085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000401637OtherMT STATE BC/BS
WV1245264928OtherOHIO WORKER'S COMP
WV300041849OtherRR MEDICARE
WV0121537000Medicaid
WV252745OtherOPTIMUM CHOICE
WV550486849 0059OtherCIGNA
WVWV10937OtherHEALTH PLAN
WV0004507104OtherAETNA
WV485042OtherNATIONAL CAPITAL PPO
WVD49326OtherWV WORKER'S COMP
WV485042OtherNATIONAL CAPITAL PPO
WV300041849OtherRR MEDICARE