Provider Demographics
NPI:1093913840
Name:FUNG, SARAVUT S (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAVUT
Middle Name:S
Last Name:FUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:527 MEDICAL PARK DR STE 400
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9010
Mailing Address - Country:US
Mailing Address - Phone:681-342-3500
Mailing Address - Fax:681-342-3507
Practice Address - Street 1:211 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2832
Practice Address - Country:US
Practice Address - Phone:304-624-5212
Practice Address - Fax:304-623-5812
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2015-10-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV09963207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0095455000Medicaid
WV406181204OtherRAILROAD MEDICARE
WVD49237Medicare UPIN
WV0419501Medicare PIN