Provider Demographics
NPI:1497718803
Name:IYER, RAMAKRISHNAN S (MD)
Entity Type:Individual
Prefix:
First Name:RAMAKRISHNAN
Middle Name:S
Last Name:IYER
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 1:2335 CHESTERFIELD AVE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1066
Mailing Address - Country:US
Mailing Address - Phone:304-346-2284
Mailing Address - Fax:304-346-6590
Practice Address - Street 1:2335 CHESTERFIELD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1066
Practice Address - Country:US
Practice Address - Phone:304-346-2284
Practice Address - Fax:304-346-7470
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV13143207RC0000X
WV13143207RI0011X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP01050055OtherMEDICARE RAILROAD
WV0087274000Medicaid
WVP01050055OtherMEDICARE RAILROAD
WVG66346Medicare UPIN
WVP01050055OtherMEDICARE RAILROAD
WA0513046Medicare ID - Type UnspecifiedCHAPMANVILLE LOCATION