| Duong Thai Ly, MD | |
|
1006 Tavern Rd, Martinsburg, WV 25401-2864 | |
| (304) 267-5141 | |
| (304) 267-5140 |
| Full Name | Duong Thai Ly |
|---|---|
| Gender | Male |
| Speciality | Anesthesiology |
| Location | 1006 Tavern Rd, Martinsburg, West Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124032917 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207L00000X | Anesthesiology | D69151 (Maryland) | Secondary |
| 207L00000X | Anesthesiology | 24121 (West Virginia) | Primary |
| 207L00000X | Anesthesiology | 0101246849 (Virginia) | Secondary |
| Entity Name | First Colonies Anesthesia Associates, Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1740218767 PECOS PAC ID: 8426039744 Enrollment ID: O20040525000119 |
| Mailing Address | Practice Location Address |
|---|---|
| Duong Thai Ly, MD Po Box 62556, Baltimore, MD 21264-2556 Ph: (302) 709-4528 | Duong Thai Ly, MD 1006 Tavern Rd, Martinsburg, WV 25401-2864 Ph: (304) 267-5141 |
Satish Kumar Menon, DO Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 94 Old Mill Rd, Martinsburg, WV 25401 Phone: 304-264-8933 Fax: 304-264-8846 | |
Sarah Mclellan, MD Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 2000 Foundation Way, Suite 3400, Martinsburg, WV 25401 Phone: 304-264-1000 | |
Linda Jones, CRNA Anesthesiology Medicare: Accepting Medicare Assignments Practice Location: 94 Old Mill Rd, Martinsburg, WV 25401 Phone: 304-264-8933 Fax: 304-264-8846 | |
Paulette Pickett, CRNA Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 94 Old Mill Rd, Martinsburg, WV 25401 Phone: 304-264-8933 Fax: 304-264-8846 | |
Danilo J Gervacio, MD Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 94 Old Mill Rd, Martinsburg, WV 25401 Phone: 304-264-8933 Fax: 304-264-8846 | |
Phillip Nicodemus, CRNA Anesthesiology Medicare: Not Enrolled in Medicare Practice Location: 94 Old Mill Rd, Martinsburg, WV 25401 Phone: 304-264-8933 Fax: 304-264-8846 |