Healthcare Provider Details

I. General information

NPI: 1699199232
Provider Name (Legal Business Name): VETTIVELU MAHESWARAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 05/24/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 N MILDRED ST
RANSON WV
25438-5552
US

IV. Provider business mailing address

1212 N MILDRED ST
RANSON WV
25438-5552
US

V. Phone/Fax

Practice location:
  • Phone: 304-724-6091
  • Fax:
Mailing address:
  • Phone: 304-724-6091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01028
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10753
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: