Doctor Name: | SURATKAL V SHENOY |
NPI Number: | 1013092337 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D.F.A.C.S |
License Number: | 12745 |
Business Practice Address: | Route 220 South Staggs Lane Keyser, WV - 267260929 |
Business Phone Number: | 3047886566 |
Business Fax Number: | 3017867050 |
Mailing Address: | Po Box 929, KEYSER |
State: | WV |
Postal Code: | 267260929 |
Phone Number: | 3047886566 |
Fax Number: | 3017867050 |
NPI Enumeration Date: | 10/26/2006 |
NPI Last Update Date: | 12/04/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 12745 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WV |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |