Provider Demographics
NPI:1003141151
Name:REGIONAL MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:REGIONAL MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-947-5350
Mailing Address - Street 1:PO BOX 2435
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1635
Mailing Address - Country:US
Mailing Address - Phone:304-723-6040
Mailing Address - Fax:304-723-6090
Practice Address - Street 1:560 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:BURGETTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15021-8539
Practice Address - Country:US
Practice Address - Phone:724-947-5350
Practice Address - Fax:724-947-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty