Provider Demographics
NPI:1649362708
Name:PIZARRO, EVANGELINE CARANDANG (MD)
Entity type:Individual
Prefix:DR
First Name:EVANGELINE
Middle Name:CARANDANG
Last Name:PIZARRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EVANGELINE
Other - Middle Name:REYES
Other - Last Name:CARANDANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2115 CHAPLINE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3859
Mailing Address - Country:US
Mailing Address - Phone:304-234-1610
Mailing Address - Fax:304-234-1739
Practice Address - Street 1:2115 CHAPLINE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3859
Practice Address - Country:US
Practice Address - Phone:304-234-1610
Practice Address - Fax:304-234-1739
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11438207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVC73090Medicare UPIN
WVP10721531Medicare ID - Type Unspecified