Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MT202639 | PA |
Y | 2080P0214X | Pediatric Pulmonologist | 28652 | WV |
NPI | 1417206509 |
---|---|
Provider Name | Miss Casandra Arevalo-Marcano |
First Address | Morgantown, WV 26506-1200 |
Second Address | Morgantown, WV 26506-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2012 |
Last Update Date | 10/01/2021 |