Provider Demographics
NPI:1477639870
Name:PURANIK, VIDYA (MD MBBS FRCSC)
Entity Type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:
Last Name:PURANIK
Suffix:
Gender:F
Credentials:MD MBBS FRCSC
Other - Prefix:
Other - First Name:VIDYA
Other - Middle Name:
Other - Last Name:KASHYAP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 STANFORD ROAD
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3140
Mailing Address - Country:US
Mailing Address - Phone:304-250-0345
Mailing Address - Fax:304-256-0185
Practice Address - Street 1:250 STANFORD ROAD
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:304-250-0345
Practice Address - Fax:304-256-0185
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18190207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0093170001Medicaid
WV0803023Medicare ID - Type Unspecified
WV0093170001Medicaid