Provider Demographics
NPI:1730149220
Name:ARCEO, LIZA A (MD)
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:A
Last Name:ARCEO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:ANTONETTE
Other - Last Name:ARCEO-FREDERICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2157 GREENBRIER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-9623
Mailing Address - Country:US
Mailing Address - Phone:304-546-0176
Mailing Address - Fax:
Practice Address - Street 1:2157 GREENBRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25311-9623
Practice Address - Country:US
Practice Address - Phone:304-546-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17975207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0062577000Medicaid
G84114Medicare UPIN
FL43294ZMedicare ID - Type Unspecified