Provider Demographics
NPI:1760421648
Name:RELLAN, DEV RAJ (MD)
Entity Type:Individual
Prefix:
First Name:DEV
Middle Name:RAJ
Last Name:RELLAN
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 1:5170 US ROUTE 60 E
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25705-2004
Mailing Address - Country:US
Mailing Address - Phone:304-528-4616
Mailing Address - Fax:304-526-3228
Practice Address - Street 1:5170 US ROUTE 60 E
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2004
Practice Address - Country:US
Practice Address - Phone:304-528-4616
Practice Address - Fax:304-526-3228
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09827207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0087912000Medicaid
111029766OtherMEDICARE RAILROAD
OH0215618Medicaid
WV0382591Medicare PIN
OH0215618Medicaid