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NPI Code Detail

MEDICARE: MRS. JAYNE LADIER CANTERBURY D.O.

MEDICARE: MRS. JAYNE LADIER CANTERBURY D.O.
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
1207Q00000XFamily Medicine Physician1562WV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100348473OTHERWVRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
200190786OTHERWVBCBS MOUNTAIN STATE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4172431OTHERWVUMWA
55004699OTHERWVAETNA

General Provider Information

NPI Number : 1760433254
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAYNE LADIER CANTERBURY D.O.
Provider Business Mailing Address
First Line : PO BOX 590
Second Line :
City : UNION
State : WV
Zip : 24983-0590
Country : US
Telephone Number : 304-772-5555
Fax Number : 304-772-5553
Provider Business Practice Location Address
First Line : 2869 SENECA TRL S
Second Line :
City : PETERSTOWN
State : WV
Zip : 24963-5037
Country : US
Telephone Number : 304-753-4336
Fax Number : 304-772-5553
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 01/29/2025

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