Provider Demographics
NPI:1023335213
Name:WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY
Entity type:Organization
Organization Name:WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NITESH
Authorized Official - Middle Name:
Authorized Official - Last Name:RATNAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-637-2360
Mailing Address - Street 1:PO BOX 2831
Mailing Address - Street 2:WEST VIRGINIA GASTROENTEROLOGY & ENDOSCOPY
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-2831
Mailing Address - Country:US
Mailing Address - Phone:304-637-2360
Mailing Address - Fax:304-637-2362
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3127
Practice Address - Country:US
Practice Address - Phone:304-637-2360
Practice Address - Fax:304-637-2362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22218207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVDR2847OtherRAILROAD MEDICARE
WV3810017597Medicaid
WVWE9389351Medicare Oscar/Certification
OHH019460Medicare Oscar/Certification