Provider Demographics
NPI:1053487736
Name:GAMPONIA, EDGAR C (MD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:C
Last Name:GAMPONIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 PINEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2713
Mailing Address - Country:US
Mailing Address - Phone:304-598-3301
Mailing Address - Fax:304-599-7346
Practice Address - Street 1:1255 PINEVIEW DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2713
Practice Address - Country:US
Practice Address - Phone:304-598-3301
Practice Address - Fax:304-599-7346
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18863207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0096473000Medicaid
WV0837224Medicare ID - Type Unspecified
WV0837221Medicare ID - Type Unspecified
WV0096473000Medicaid
WV180033657Medicare PIN
G65666Medicare UPIN
MD055L819ZMedicare ID - Type Unspecified
WV180031493Medicare PIN