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General NPI Number Information
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NPI Number | 1538270590
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Entity Type | Individual
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Provider Name | PRAKASH RAGHUNATH PURANIK MD
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/17/2018
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Provider Practice Location Address
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Address Line | 250 STANAFORD RD
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City | BECKLEY
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State | WV
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Zip | 25801-3140
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Country | US
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Telephone | 304-466-2944
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Fax | 304-466-2943
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Provider Business Mailing Address
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Address Line | 1802 HARPER RD STE 102
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City | BECKLEY
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State | WV
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Zip | 25801-3376
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Country | US
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Telephone | 304-466-2944
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Fax | 304-466-2943
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 18189
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License Number State | WV
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