Healthcare Provider Details

I. General information

NPI: 1093341612
Provider Name (Legal Business Name): PHYSICIAN ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2020
Last Update Date: 03/15/2020
Certification Date: 03/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 HARPER RD
BECKLEY WV
25801-3366
US

IV. Provider business mailing address

1842 HARPER RD
BECKLEY WV
25801-3366
US

V. Phone/Fax

Practice location:
  • Phone: 304-237-3487
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NITEESH BHARARA
Title or Position: PRESIDENT
Credential: MD
Phone: 205-910-7056