Provider Demographics
NPI:1043215791
Name:WINFRED, RAJEEV (MD)
Entity Type:Individual
Prefix:
First Name:RAJEEV
Middle Name:
Last Name:WINFRED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26507-0696
Mailing Address - Country:US
Mailing Address - Phone:304-685-6218
Mailing Address - Fax:304-368-5204
Practice Address - Street 1:2734 SUNCREST VLG
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3844
Practice Address - Country:US
Practice Address - Phone:304-685-6218
Practice Address - Fax:304-368-5204
Is Sole Proprietor?:No
Enumeration Date:2005-06-19
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19812207R00000X, 208000000X, 208M00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6000605000Medicaid
H05729Medicare UPIN
WV6000605000Medicaid