Healthcare Provider Details

I. General information

NPI: 1780613984
Provider Name (Legal Business Name): PLEASANT VALLEY RADIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 03/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 VALLEY DR
POINT PLEASANT WV
25550-2031
US

IV. Provider business mailing address

PO BOX 236
POINT PLEASANT WV
25550-0236
US

V. Phone/Fax

Practice location:
  • Phone: 304-675-4340
  • Fax: 304-675-5893
Mailing address:
  • Phone: 614-430-5726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SURESH K AGRAWAL
Title or Position: PRESIDENT
Credential: MD
Phone: 304-675-4340