Healthcare Provider Details

I. General information

NPI: 1528218435
Provider Name (Legal Business Name): FLAVIA GUIMARAES NUNES ROSADO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FLAVIA GUIMARAES NUNES MD

II. Dates (important events)

Enumeration Date: 09/27/2008
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STADIUM DR
MORGANTOWN WV
26506-7900
US

IV. Provider business mailing address

1 STADIUM DR
MORGANTOWN WV
26506-7900
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-3214
  • Fax:
Mailing address:
  • Phone: 304-293-3214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number25768
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number54981
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: