Basic Information
| Provider Information | |||||||||
| NPI: | 1023335213 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2831 | ||||||||
| Address2: | WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY | ||||||||
| City: | ELKINS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 262412831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046372360 | ||||||||
| FaxNumber: | 3046372362 | ||||||||
| Practice Location | |||||||||
| Address1: | 213 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ELKINS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 262413127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046372360 | ||||||||
| FaxNumber: | 3046372362 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2010 | ||||||||
| LastUpdateDate: | 03/20/2014 | ||||||||
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| AuthorizedOfficialLastName: | RATNAKAR | ||||||||
| AuthorizedOfficialFirstName: | NITESH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3046372360 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 22218 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | DR2847 | 01 | WV | RAILROAD MEDICARE | OTHER | 3810017597 | 05 | WV | MEDICAID |