Provider Demographics
NPI:1174790729
Name:FAMULARCANO, LEA GRACE RAMOS (MD)
Entity type:Individual
Prefix:
First Name:LEA GRACE
Middle Name:RAMOS
Last Name:FAMULARCANO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4111 1ST AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143-1345
Mailing Address - Country:US
Mailing Address - Phone:304-397-5744
Mailing Address - Fax:304-757-0964
Practice Address - Street 1:1041 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 306
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526
Practice Address - Country:US
Practice Address - Phone:304-397-5744
Practice Address - Fax:304-757-0964
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2017-01-19
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Provider Licenses
StateLicense IDTaxonomies
WV24101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV24101OtherSTATE LICENSE