Healthcare Provider Details

I. General information

NPI: 1679572051
Provider Name (Legal Business Name): ALFONSO P CINCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 HOSPITAL DR
GRANTSVILLE WV
26147-7100
US

IV. Provider business mailing address

186 HOSPITAL DR
GRANTSVILLE WV
26147-7100
US

V. Phone/Fax

Practice location:
  • Phone: 304-354-9244
  • Fax: 304-354-9323
Mailing address:
  • Phone: 304-354-9244
  • Fax: 304-354-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16604
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number16604
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: