Basic Information
Provider Information
NPI: 1003149634
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMANATHAN
FirstName: VIGNESHWARAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 327 MEDICAL PARK DR
Address2:  
City: BRIDGEPORT
State: WV
PostalCode: 263309006
CountryCode: US
TelephoneNumber: 6813421000
FaxNumber:  
Practice Location
Address1: 327 MEDICAL PARK DR
Address2:  
City: BRIDGEPORT
State: WV
PostalCode: 263309006
CountryCode: US
TelephoneNumber: 6813421000
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/15/2009
LastUpdateDate: 01/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000X24548WVY Allopathic & Osteopathic PhysiciansHospitalist 

ID Information
IDTypeStateIssuerDescription
13174011401NYHOSPITALOTHER


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