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General NPI Number Information
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NPI Number | 1659685246
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Entity Type | Organization
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Legal Business Name | SURATKAL V SHENOY MD PC
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | RT 220 SOUTH AND STAGGS LANE
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City | KEYSER
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State | WV
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Zip | 26726
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Country | US
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Telephone | 304-788-6566
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Fax | 301-786-7050
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Provider Business Mailing Address
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Address Line | PO BOX 929
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City | KEYSER
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State | WV
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Zip | 26726-0929
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Country | US
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Telephone | 304-788-6566
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Fax | 301-786-7050
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | DR. SURATKAL V SHENOY
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Credential | MD
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Telephone | 304-788-6566
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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 | 12745
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License Number State | WV
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