Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 24136 | WV |
NPI | 1053520577 |
---|---|
Provider Name | Divya S. Rajan |
First Address | Beckley, WV 25801-3366 |
Second Address | Beckley, WV 25801-3366 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 20/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3810018948 | (05) | WV |