Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 25730 | WV |
NPI | 1033353081 |
---|---|
Provider Name | Samip Jayantilal Borad |
First Address | Charleston, WV 25301-1842 |
Second Address | Charleston, WV 25301-1842 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2009 |
Last Update Date | 18/09/2014 |