Provider Demographics
NPI:1699762914
Name:BOFILL, RANO SOLIDUM (MD)
Entity type:Individual
Prefix:
First Name:RANO
Middle Name:SOLIDUM
Last Name:BOFILL
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:PO BOX 56
Mailing Address - Street 2:
Mailing Address - City:MAN
Mailing Address - State:WV
Mailing Address - Zip Code:25635-0056
Mailing Address - Country:US
Mailing Address - Phone:304-583-2998
Mailing Address - Fax:304-583-2998
Practice Address - Street 1:420 TEAYS BRANCH
Practice Address - Street 2:CAREMORE PAIN MGT
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240
Practice Address - Country:US
Practice Address - Phone:606-789-7246
Practice Address - Fax:606-789-4392
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV095122085R0202X
KY16535208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0123526000Medicaid
0565312Medicare ID - Type Unspecified
WV0123526000Medicaid