Healthcare Provider Details

I. General information

NPI: 1689638611
Provider Name (Legal Business Name): EDUARDO PINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR SUITE 3500
HUNTINGTON WV
25701-3656
US

IV. Provider business mailing address

1600 MEDICAL CENTER DR SUITE 3500
HUNTINGTON WV
25701-3656
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1300
  • Fax: 304-691-1375
Mailing address:
  • Phone: 304-691-1300
  • Fax: 304-691-1375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number14709
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: