Provider Demographics
NPI:1467522094
Name:NARAYAN, MYSORE G (MD)
Entity Type:Individual
Prefix:MR
First Name:MYSORE
Middle Name:G
Last Name:NARAYAN
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 288
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25502
Mailing Address - Country:US
Mailing Address - Phone:304-525-6440
Mailing Address - Fax:304-525-1099
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE #500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702
Practice Address - Country:US
Practice Address - Phone:304-525-6440
Practice Address - Fax:304-525-1099
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12322207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0083330000Medicaid
WV3810005881Medicaid
9271282Medicare ID - Type UnspecifiedGRP #
D49327Medicare UPIN
WV0083330000Medicaid