Healthcare Provider Details

I. General information

NPI: 1164400230
Provider Name (Legal Business Name): AJAY ANAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 SUMMERS HOSPITAL RD
HINTON WV
25951-5172
US

IV. Provider business mailing address

PO BOX 126 1500 TERRACE STREET
HINTON WV
25951-0126
US

V. Phone/Fax

Practice location:
  • Phone: 304-466-2918
  • Fax:
Mailing address:
  • Phone: 304-466-1660
  • Fax: 304-466-2917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number21114
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: