Healthcare Provider Details

I. General information

NPI: 1801895016
Provider Name (Legal Business Name): DAKSHINA R MURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAMAMURTHY DAKSHINAMURTHY MD

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 04/18/2022
Certification Date: 04/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PADUCAH DR
NEW MARTINSVILLE WV
26155-2710
US

IV. Provider business mailing address

800 WHEELING AVE
GLEN DALE WV
26038-1660
US

V. Phone/Fax

Practice location:
  • Phone: 304-815-0050
  • Fax: 304-815-0051
Mailing address:
  • Phone: 304-845-0100
  • Fax: 304-845-9879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01049593A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number29762
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: