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NPI Code Detail

MEDICARE: VISAVIS HEALTH CARE MEDICAL GROUP OF WV PLLC

MEDICARE: VISAVIS HEALTH CARE MEDICAL GROUP OF WV PLLC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1215792155
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISAVIS HEALTH CARE MEDICAL GROUP OF WV PLLC
Provider Business Mailing Address
First Line : 831 BEDFORD AVE STE 530
Second Line :
City : BROOKLYN
State : NY
Zip : 11205-2801
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1390 N POPLAR FORK RD
Second Line :
City : HURRICANE
State : WV
Zip : 25526-7112
Country : US
Telephone Number : 929-491-7333
Fax Number :
Authorized Official
Title or Position : OWNER
Name : REKHA BHANDARI
Credential :
Telephone Number : 212-734-6621
Provider Enumeration Date : 02/20/2024
Last Update Date : 05/07/2024

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