Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 19812 | WV |
Y | 111NI0900X | Internist | 19812 | WV |
N | 207RH0002X | Hospice and Palliative Medicine | 19812 | WV |
N | 208000000X | Pediatrician | 19812 | WV |
NPI | 1043215791 |
---|---|
Provider Name | Rajeev Winfred |
First Address | Morgantown, WV 26507-0696 |
Second Address | Morgantown, WV 26505-3844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2005 |
Last Update Date | 08/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6000605000 | (05) | WV |
H05729 | (02) |