Provider Demographics
NPI:1407136385
Name:KANAWHA VALLEY NEUROLOGY
Entity Type:Organization
Organization Name:KANAWHA VALLEY NEUROLOGY
Other - Org Name:BECKLEY SLEEP CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SASIDHARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TARAVATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-766-7695
Mailing Address - Street 1:70 BROOKSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-6765
Mailing Address - Country:US
Mailing Address - Phone:304-766-7695
Mailing Address - Fax:304-766-7698
Practice Address - Street 1:70 BROOKSHIRE LN
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-6765
Practice Address - Country:US
Practice Address - Phone:304-766-7695
Practice Address - Fax:304-766-7698
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KANAWHA VALLEY NEUROLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVE49818174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty