MEDICARE: ERNESTO H AGBAYANI MD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	19905	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407072663
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERNESTO H AGBAYANI MD PLLC

Provider Business Mailing Address
First Line	:	155 HEALTH CARE LN
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-4008
Country	:	US
Telephone Number	:	304-596-6911
Fax Number	:	304-596-6913

Provider Business Practice Location Address
First Line	:	155 HEALTH CARE LN
Second Line	:
City	:	MARTINSBURG
State	:	WV
Zip	:	25401-4008
Country	:	US
Telephone Number	:	304-596-6911
Fax Number	:	304-596-6913

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. ERNESTO H AGBAYANI
Credential	:	MD
Telephone Number	:	304-596-6911

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	04/15/2013

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