Provider Demographics
NPI:1295798098
Name:VIDOT, MILAGROS MERCEDES (MD)
Entity type:Individual
Prefix:DR
First Name:MILAGROS
Middle Name:MERCEDES
Last Name:VIDOT
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 1:500 CHERRY ST
Mailing Address - Street 2:ATTN: HOSPITALISTS OFFICE
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-3306
Mailing Address - Country:US
Mailing Address - Phone:304-327-1145
Mailing Address - Fax:304-327-1139
Practice Address - Street 1:500 CHERRY ST
Practice Address - Street 2:ATTN: HOSPITALISTS OFFICE
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-3306
Practice Address - Country:US
Practice Address - Phone:304-327-1145
Practice Address - Fax:304-327-1139
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20921207P00000X
VA0101240661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1808426000Medicaid
WV001722256OtherBLUE CROSS BLUE SHIELD
WV001722256OtherBLUE CROSS BLUE SHIELD
WV1808426000Medicaid
WV4157822Medicare PIN
WV4157826Medicare PIN
WV4157823Medicare PIN