MEDICARE: DR. LEO PANTILLA PAJARILLO M.D.

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	208D00000X	General Practice Physician	11772	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497971212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO PANTILLA PAJARILLO M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2080
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-2080
Country	:	US
Telephone Number	:	304-236-5902
Fax Number	:	304-235-4049

Provider Business Practice Location Address
First Line	:	186 E 2ND AVE STE 100
Second Line	:
City	:	WILLIAMSON
State	:	WV
Zip	:	25661-3602
Country	:	US
Telephone Number	:	304-236-5902
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	01/05/2024

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