=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003141151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGIONAL MEDICAL GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2009
-----------------------------------------------------
Last Update Date | 10/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 560 STEUBENVILLE PIKE
-----------------------------------------------------
City | BURGETTSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15021-8539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-947-5350
-----------------------------------------------------
Fax | 724-947-0206
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2435
-----------------------------------------------------
City | WEIRTON
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26062-1635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-723-6040
-----------------------------------------------------
Fax | 304-723-6090
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING PARTNER
-----------------------------------------------------
Name | DR. CHERIAN JOHN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 724-947-5350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------