Healthcare Provider Details

I. General information

NPI: 1083709562
Provider Name (Legal Business Name): JAMES P. VIGLIANCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PIN OAK LN
KEYSER WV
26726-5908
US

IV. Provider business mailing address

100 PIN OAK LN
KEYSER WV
26726-5908
US

V. Phone/Fax

Practice location:
  • Phone: 304-597-3797
  • Fax:
Mailing address:
  • Phone: 304-597-3797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number246712
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number246712
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35060450V
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number26992
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: