Provider Demographics
NPI:1164037818
Name:RATHORE, BALDEV KRISHAN
Entity Type:Individual
Prefix:
First Name:BALDEV
Middle Name:KRISHAN
Last Name:RATHORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 VILLAGE CREST DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1700
Mailing Address - Country:US
Mailing Address - Phone:681-209-4218
Mailing Address - Fax:
Practice Address - Street 1:131 VILLAGE CREST DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-1700
Practice Address - Country:US
Practice Address - Phone:681-209-4218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant