MEDICARE: RAJAN MASIH M.D.

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	207P00000X	Emergency Medicine Physician	19166	WV
2	207P00000X	Emergency Medicine Physician	8173	MT
3	207P00000X	Emergency Medicine Physician	20646	NE
4	207P00000X	Emergency Medicine Physician	97402	WI

General Provider Information

NPI Number	:	1275630097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAJAN MASIH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 365
Second Line	:
City	:	PETERSBURG
State	:	WV
Zip	:	26847-0365
Country	:	US
Telephone Number	:	304-257-4204
Fax Number	:

Provider Business Practice Location Address
First Line	:	712 N MAIN ST
Second Line	:	SUITE 201
City	:	MOOREFIELD
State	:	WV
Zip	:	26836-1092
Country	:	US
Telephone Number	:	304-530-4999
Fax Number	:	304-257-4204

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/01/2008

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