Healthcare Provider Details

I. General information

NPI: 1376520197
Provider Name (Legal Business Name): PHILIP B LEPANTO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 US ROUTE 60 E RADIOLOGY INC
HUNTINGTON WV
25705-2022
US

IV. Provider business mailing address

PO BOX 910 RADIOLOGY INC
HUNTINGTON WV
25712-0910
US

V. Phone/Fax

Practice location:
  • Phone: 304-522-1550
  • Fax: 304-522-0704
Mailing address:
  • Phone: 304-522-1550
  • Fax: 304-522-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number11879
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number15899
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: