Provider Demographics
NPI:1326294927
Name:VIDYA P PURANIK
Entity Type:Organization
Organization Name:VIDYA P PURANIK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GENEVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-253-5793
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:CRAB ORCHARD
Mailing Address - State:WV
Mailing Address - Zip Code:25827-0787
Mailing Address - Country:US
Mailing Address - Phone:304-253-5793
Mailing Address - Fax:304-253-0166
Practice Address - Street 1:250 STANAFORD RD
Practice Address - Street 2:SUITE ONE
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3140
Practice Address - Country:US
Practice Address - Phone:304-253-5793
Practice Address - Fax:304-253-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-14
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty