Healthcare Provider Details

I. General information

NPI: 1891997680
Provider Name (Legal Business Name): PARESH VINOD LAKHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4840 KENTUCKY ST
SOUTH CHARLESTON WV
25309-1310
US

IV. Provider business mailing address

4840 KENTUCKY ST
SOUTH CHARLESTON WV
25309-1310
US

V. Phone/Fax

Practice location:
  • Phone: 304-768-7384
  • Fax: 304-768-3377
Mailing address:
  • Phone: 304-768-7384
  • Fax: 304-768-3377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.057340
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number23789
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: