Provider Demographics
NPI:1073903373
Name:MID-OHIO VALLEY NEPHROLOGY ASSOCIATION
Entity Type:Organization
Organization Name:MID-OHIO VALLEY NEPHROLOGY ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RABINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK-HAMIRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-834-3970
Mailing Address - Street 1:800 GRAND CENTRAL MALL
Mailing Address - Street 2:SUITE 9
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105-4100
Mailing Address - Country:US
Mailing Address - Phone:304-834-3970
Mailing Address - Fax:304-916-1871
Practice Address - Street 1:800 GRAND CENTRAL MALL
Practice Address - Street 2:SUITE 9
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105-4100
Practice Address - Country:US
Practice Address - Phone:304-834-3970
Practice Address - Fax:304-916-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV25689207Q00000X, 207QG0300X
WV20965207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty