Healthcare Provider Details

I. General information

NPI: 1962458687
Provider Name (Legal Business Name): MYSORE G NARAYAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 1ST AVE SUITE #500
HUNTINGTON WV
25702
US

IV. Provider business mailing address

PO BOX 288
BARBOURSVILLE WV
25504
US

V. Phone/Fax

Practice location:
  • Phone: 304-525-6440
  • Fax: 304-525-1099
Mailing address:
  • Phone: 304-525-6440
  • Fax: 304-525-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12322
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number12322
License Number StateWV

VIII. Authorized Official

Name: MR. MYSORE G NARAYAN I
Title or Position: PRESIDENT
Credential: MD
Phone: 304-525-6440