Healthcare Provider Details

I. General information

NPI: 1093702698
Provider Name (Legal Business Name): DIONISIO E POLICARPIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 WASHINGTON ST W
CHARLESTON WV
25302-2345
US

IV. Provider business mailing address

209 WASHINGTON ST W
CHARLESTON WV
25302-2345
US

V. Phone/Fax

Practice location:
  • Phone: 304-344-8000
  • Fax: 304-344-8001
Mailing address:
  • Phone: 304-344-8000
  • Fax: 304-344-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberWV11439
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: