Healthcare Provider Details

I. General information

NPI: 1972697969
Provider Name (Legal Business Name): PANAYOTIS IGNATIADIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/19/2022
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 1ST AVE OPC SUITE 10
HUNTINGTON WV
25702-0107
US

IV. Provider business mailing address

PO BOX 4190
BARBOURSVILLE WV
25504-4190
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-6825
  • Fax: 304-525-0300
Mailing address:
  • Phone: 304-399-4405
  • Fax: 304-399-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number12268
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: