Healthcare Provider Details

I. General information

NPI: 1023468014
Provider Name (Legal Business Name): RUPESH KUMAR NATARAJAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 09/02/2023
Certification Date: 09/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DR
MORGANTOWN WV
26506-1200
US

IV. Provider business mailing address

56 WINDERMERE LN
MORGANTOWN WV
26508-1900
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-4451
  • Fax:
Mailing address:
  • Phone: 201-423-6724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number32374
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: