Provider Demographics
NPI:1326808718
Name:AVASARALA, VARDHAN SESHASAI (MD)
Entity Type:Individual
Prefix:DR
First Name:VARDHAN
Middle Name:SESHASAI
Last Name:AVASARALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9238
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9238
Mailing Address - Country:US
Mailing Address - Phone:304-293-7480
Mailing Address - Fax:304-293-2556
Practice Address - Street 1:1 MEDICAL CENTER DR # 2937480
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-1200
Practice Address - Country:US
Practice Address - Phone:304-293-7480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program