1912049552 NPI number — MADHU N DHARAWAT MD

Table of content: (NPI 1912049552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912049552 NPI number — MADHU N DHARAWAT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADHU N DHARAWAT MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912049552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
426 8TH ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
GLEN DALE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26038-1451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-845-0100
Provider Business Mailing Address Fax Number:
304-845-9879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
426 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
GLEN DALE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26038-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-845-0100
Provider Business Practice Location Address Fax Number:
304-845-9879
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DHARAWAT
Authorized Official First Name:
MADHU
Authorized Official Middle Name:
N
Authorized Official Title or Position:
SOLE PROPRIETOR CARDIOLOGIST
Authorized Official Telephone Number:
304-845-0100

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  21010 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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