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General NPI Number Information
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NPI Number | 1538124680
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Entity Type | Individual
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Provider Name | VIJAYKUMAR R PHADE MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 496 CHERRY ST BLDG C STE A
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City | BLUEFIELD
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State | WV
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Zip | 24701-3304
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Country | US
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Telephone | 304-327-7476
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Fax | 304-327-7476
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Provider Business Mailing Address
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Address Line | PO BOX 1553
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City | BLUEFIELD
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State | WV
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Zip | 24701
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Country | US
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Telephone | 304-327-7476
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Fax | 304-327-7476
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 12519
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101037661
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License Number State | VA
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