Healthcare Provider Details

I. General information

NPI: 1457572604
Provider Name (Legal Business Name): KESARI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 PRICHARD RD
DANVILLE WV
25053
US

IV. Provider business mailing address

163 PRICHARD RD
DANVILLE WV
25053
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-4290
  • Fax:
Mailing address:
  • Phone: 304-369-4290
  • Fax: 304-369-4289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SRIRAMLOO KESARI
Title or Position: PRESIDENT
Credential: MD
Phone: 304-369-4290