Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 25386 | WV |
NPI | 1134428980 |
---|---|
Provider Name | Kumar Rai |
First Address | Stanaford, WV 25927 |
Second Address | Beckley, WV 25801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2011 |
Last Update Date | 24/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000007228 | METROPLUSGOLD (01) | NY |