Healthcare Provider Details

I. General information

NPI: 1326166463
Provider Name (Legal Business Name): KANAWHA VALLEY NEUROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3847 TEAYS VALLEY RD SUITE D
HURRICANE WV
25526-9622
US

IV. Provider business mailing address

3847 TEAYS VALLEY ROAD SUITE D
HURRICANE WV
25526
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-5337
  • Fax: 304-757-7537
Mailing address:
  • Phone: 304-757-5337
  • Fax: 304-757-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number18764
License Number StateWV

VIII. Authorized Official

Name: DR. SASIDHARAN TARAVATH
Title or Position: PRESIDENT
Credential: MD
Phone: 304-757-5337