Healthcare Provider Details

I. General information

NPI: 1871734558
Provider Name (Legal Business Name): MEDICAL SONOIMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EUREKA RD
CHARLESTON WV
25314-2126
US

IV. Provider business mailing address

250 EUREKA RD
CHARLESTON WV
25314-2126
US

V. Phone/Fax

Practice location:
  • Phone: 304-342-0556
  • Fax: 304-342-0556
Mailing address:
  • Phone: 304-342-0556
  • Fax: 304-342-0556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number2085U0001X
License Number StateWV

VIII. Authorized Official

Name: RAVINDRA P MALAPUR
Title or Position: ULTRASONOGRAPHER
Credential: MBBS,DGO,MD,ARDMS
Phone: 304-342-0556