Healthcare Provider Details

I. General information

NPI: 1922047240
Provider Name (Legal Business Name): BABU PAUL MATTAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/12/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 SPRING VALLEY DRIVE
HUNTINGTON WV
25704
US

IV. Provider business mailing address

1540 SPRING VALLEY DRIVE
HUNTINGTON WV
25704
US

V. Phone/Fax

Practice location:
  • Phone: 304-429-6741
  • Fax: 304-429-0262
Mailing address:
  • Phone: 304-429-6741
  • Fax: 304-429-0262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number222480
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: