Provider Demographics
NPI:1629167424
Name:BHIRUD, RAVIN (M D)
Entity Type:Individual
Prefix:
First Name:RAVIN
Middle Name:
Last Name:BHIRUD
Suffix:
Gender:M
Credentials:M D
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 539
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-0539
Mailing Address - Country:US
Mailing Address - Phone:304-442-2567
Mailing Address - Fax:304-442-2567
Practice Address - Street 1:401 6TH AVE STE 201
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2116
Practice Address - Country:US
Practice Address - Phone:304-442-2569
Practice Address - Fax:304-442-2569
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV13752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0084139000Medicaid
WVB42810Medicare UPIN
WV8804522Medicare PIN