Provider Demographics
NPI:1275809535
Name:WEIRTON MEDICAL CENTER
Entity Type:Organization
Organization Name:WEIRTON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRAVEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDALA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:304-797-6000
Mailing Address - Street 1:5313 TERRACE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-3530
Mailing Address - Country:US
Mailing Address - Phone:304-797-6436
Mailing Address - Fax:
Practice Address - Street 1:601 COLLIERS WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5014
Practice Address - Country:US
Practice Address - Phone:304-797-6000
Practice Address - Fax:304-797-6186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV511133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty