Provider Demographics
NPI:1356427371
Name:ANGCO, MANUEL M (MD)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:M
Last Name:ANGCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:701 COLLEGE HL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-3300
Mailing Address - Country:US
Mailing Address - Phone:304-235-5389
Mailing Address - Fax:304-235-2010
Practice Address - Street 1:701 COLLEGE HL
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-3300
Practice Address - Country:US
Practice Address - Phone:304-235-5389
Practice Address - Fax:304-235-2010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV14440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64693971Medicaid
WV0051246000Medicaid
WVD99695Medicare UPIN
WVAN8803683Medicare ID - Type Unspecified