MEDICARE: MR. ROMULO GANUELAS DELA ROSA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	14275	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	14275	OTHER	WV	LIC WV

General Provider Information

NPI Number	:	1134221153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROMULO GANUELAS DELA ROSA MD

Provider Business Mailing Address
First Line	:	PO BOX 7
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-0007
Country	:	US
Telephone Number	:	304-938-2955
Fax Number	:	304-938-2955

Provider Business Practice Location Address
First Line	:	26 MAIN STREET
Second Line	:
City	:	IAEGER
State	:	WV
Zip	:	24844
Country	:	US
Telephone Number	:	304-938-2955
Fax Number	:	304-938-2955

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2006
Last Update Date	:	03/07/2023

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