Provider Demographics
NPI:1699199232
Name:MAHESWARAN, VETTIVELU
Entity Type:Individual
Prefix:
First Name:VETTIVELU
Middle Name:
Last Name:MAHESWARAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 N MILDRED ST
Mailing Address - Street 2:
Mailing Address - City:RANSON
Mailing Address - State:WV
Mailing Address - Zip Code:25438-5552
Mailing Address - Country:US
Mailing Address - Phone:304-724-6091
Mailing Address - Fax:
Practice Address - Street 1:1212 N MILDRED ST
Practice Address - Street 2:
Practice Address - City:RANSON
Practice Address - State:WV
Practice Address - Zip Code:25438-5552
Practice Address - Country:US
Practice Address - Phone:304-724-6091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01028207V00000X
WV10753207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV10753OtherTHE MEDICAL LICENSING BOARD OF WEST VIRGINIA
WV01028OtherWEST VIRGINIA BOARD OF MEDICAL EXAMINERS VOLUNTEER PROVIDER NUMBER