Healthcare Provider Details

I. General information

NPI: 1730920364
Provider Name (Legal Business Name): JULIUS MYURAN NAGARATNAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 07/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVENUE, S.E.
CHARLESTON WV
25304
US

IV. Provider business mailing address

3200 MACCORKLE AVENUE, S.E.
CHARLESTON WV
25304
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-4600
  • Fax: 304-388-4603
Mailing address:
  • Phone: 304-388-4600
  • Fax: 304-388-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: