Healthcare Provider Details

I. General information

NPI: 1497718803
Provider Name (Legal Business Name): RAMAKRISHNAN S IYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 CHESTERFIELD AVE SUITE 202
CHARLESTON WV
25304-1066
US

IV. Provider business mailing address

2335 CHESTERFIELD AVE 202
CHARLESTON WV
25304-1066
US

V. Phone/Fax

Practice location:
  • Phone: 304-346-2284
  • Fax: 304-346-7470
Mailing address:
  • Phone: 304-346-2284
  • Fax: 304-346-6590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberWV13143
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number13143
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number13143
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: