Healthcare Provider Details

I. General information

NPI: 1295239614
Provider Name (Legal Business Name): JUAN CARLO AVALON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
MORGANTOWN WV
26506
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE P.O. BOX 9001-A
MORGANTOWN WV
26506
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-2463
  • Fax: 304-293-5160
Mailing address:
  • Phone: 304-293-2463
  • Fax: 304-293-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3828
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: