Provider Demographics
NPI:1447347299
Name:DAVIDSON-DAGOSTINE, RAMONA A (MD)
Entity type:Individual
Prefix:DR
First Name:RAMONA
Middle Name:A
Last Name:DAVIDSON-DAGOSTINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4607 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1364
Mailing Address - Country:US
Mailing Address - Phone:304-768-7228
Mailing Address - Fax:304-768-7772
Practice Address - Street 1:4607 MACCORKLE AVE SW
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1364
Practice Address - Country:US
Practice Address - Phone:304-768-7228
Practice Address - Fax:304-768-7772
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19827207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6200036000Medicaid
WVH06182Medicare UPIN
WV6200036000Medicaid