Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 15337 | WV |
NPI | 1184654832 |
---|---|
Provider Name | Dr. Sivaparvati Thagirisa |
First Address | Fairmont, WV 26554-1307 |
Second Address | Clarksburg, WV 26301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 08/07/2007 |