Provider Demographics
NPI:1023055209
Name:ESTALILLA, OSCAR CINCO (MD)
Entity type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:CINCO
Last Name:ESTALILLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:415 MORRIS STREET
Mailing Address - Street 2:SUITE 304
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301
Mailing Address - Country:US
Mailing Address - Phone:304-388-7782
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:3200 MACCORKLE AVENUE SE
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5550
Practice Address - Fax:304-388-4352
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-07-15
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Provider Licenses
StateLicense IDTaxonomies
WV20193207ZP0102X
PAMD 067762 L207ZP0102X
TXK8137207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ES4280441Medicare PIN
ES7285371Medicare PIN
G97524Medicare UPIN
P00827253Medicare UPIN