MEDICARE: RAJIV K. JAIN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1666	WV
2	207Q00000X	Family Medicine Physician	34.007367	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1057639	OTHER		COMPNET
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	63154600	OTHER	WV	BLACK LUNG
5	3232099	OTHER	WV	CIGNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124008917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJIV K. JAIN DO

Provider Business Mailing Address
First Line	:	PO BOX 88
Second Line	:	5 E ALVON ROAD SUITE 7
City	:	WHITE SULPHUR SPRINGS
State	:	WV
Zip	:	24986-2373
Country	:	US
Telephone Number	:	304-536-5030
Fax Number	:	304-536-5031

Provider Business Practice Location Address
First Line	:	2900 1ST AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1241
Country	:	US
Telephone Number	:	304-399-7484
Fax Number	:	304-399-7579

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	03/24/2016

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Directions to “ RAJIV K. JAIN DO” Practice Location

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