Healthcare Provider Details

I. General information

NPI: 1760421648
Provider Name (Legal Business Name): DEV RAJ RELLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 US ROUTE 60 E
HUNTINGTON WV
25705-2004
US

IV. Provider business mailing address

5170 US ROUTE 60 E
HUNTINGTON WV
25705-2004
US

V. Phone/Fax

Practice location:
  • Phone: 304-528-4616
  • Fax: 304-526-3228
Mailing address:
  • Phone: 304-528-4616
  • Fax: 304-526-3228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number09827
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: