Provider Demographics
NPI:1962458687
Name:MYSORE G NARAYAN
Entity Type:Organization
Organization Name:MYSORE G NARAYAN
Other - Org Name:MYSORE G NARAYAN MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MYSORE
Authorized Official - Middle Name:G
Authorized Official - Last Name:NARAYAN
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:304-525-6440
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504
Mailing Address - Country:US
Mailing Address - Phone:304-525-6440
Mailing Address - Fax:304-525-1099
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:SUITE #500
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702
Practice Address - Country:US
Practice Address - Phone:304-525-6440
Practice Address - Fax:304-525-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12322207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0437478Medicaid
WV0083330000Medicaid
0481967Medicare ID - Type Unspecified
OH0437478Medicaid
D49327Medicare UPIN