Healthcare Provider Details

I. General information

NPI: 1912049552
Provider Name (Legal Business Name): MADHU N DHARAWAT MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 8TH ST SUITE 301
GLEN DALE WV
26038-1451
US

IV. Provider business mailing address

426 8TH ST SUITE 301
GLEN DALE WV
26038-1451
US

V. Phone/Fax

Practice location:
  • Phone: 304-845-0100
  • Fax: 304-845-9879
Mailing address:
  • Phone: 304-845-0100
  • Fax: 304-845-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number21010
License Number StateWV

VIII. Authorized Official

Name: DR. MADHU N DHARAWAT
Title or Position: SOLE PROPRIETOR CARDIOLOGIST
Credential: M.D.
Phone: 304-845-0100