Healthcare Provider Details

I. General information

NPI: 1982625554
Provider Name (Legal Business Name): KENNETH C RAMDAT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
CLARKSBURG WV
26301
US

IV. Provider business mailing address

1 MEDICAL CENTER DRIVE
CLARKSBURG WV
26301
US

V. Phone/Fax

Practice location:
  • Phone: 304-623-3461
  • Fax:
Mailing address:
  • Phone: 304-623-3461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number015925
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: