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General NPI Number Information
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NPI Number | 1134221153
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Entity Type | Individual
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Provider Name | ROMULO GANUELAS DELA ROSA MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 26 MAIN STREET
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City | IAEGER
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State | WV
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Zip | 24844
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Country | US
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Telephone | 304-938-2955
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Fax | 304-938-2955
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | PRINCETON
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State | WV
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Zip | 24740-0007
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Country | US
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Telephone | 304-938-2955
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Fax | 304-938-2955
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 14275
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License Number State | WV
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