MEDICARE: DR. BALAJI GOVINDASWAMI MD

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	208000000X	Pediatrics Physician	29449	WV
2	2080N0001X	Neonatal-Perinatal Medicine Physician	A49410	CA
3	2080N0001X	Neonatal-Perinatal Medicine Physician	29449	WV

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

General Provider Information

NPI Number	:	1265419436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BALAJI GOVINDASWAMI MD

Provider Business Mailing Address
First Line	:	1448 10TH AVE STE 304
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3579
Country	:	US
Telephone Number	:	304-691-8714
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 MEDICAL CENTER DR STE 3500
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25701-3655
Country	:	US
Telephone Number	:	304-691-1300
Fax Number	:

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	11/30/2021

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