Provider Demographics
NPI:1053541797
Name:ASENCIO MAGDALENO, LUIS ALEJANDRO (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS ALEJANDRO
Middle Name:
Last Name:ASENCIO MAGDALENO
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 1:1717 HARPER RD
Mailing Address - Street 2:SECOND FLOOR, SUITE G
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3373
Mailing Address - Country:US
Mailing Address - Phone:304-461-3922
Mailing Address - Fax:
Practice Address - Street 1:1717 HARPER RD
Practice Address - Street 2:SECOND FLOOR, SUITE G
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3373
Practice Address - Country:US
Practice Address - Phone:304-461-3922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-15
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59498207RI0011X
AZR71727390200000X
WV26928207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program