Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 1453 | WV |
N | 207QA0401X | Family Doctor - Addiction Medicine | 1453 | WV |
NPI | 1861432593 |
---|---|
Provider Name | Louis A Yancich |
First Address | Point Pleasant, WV 25550-0470 |
Second Address | Millwood, WV 25262-8100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 15/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200809220 | (05) | IN |
F53544 | (02) |