Provider Demographics
NPI:1205462330
Name:MADAPATHI, PRAVEENA (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVEENA
Middle Name:
Last Name:MADAPATHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 GARFIELD AVE RM G-102
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-5376
Mailing Address - Country:US
Mailing Address - Phone:304-424-4575
Mailing Address - Fax:304-424-4577
Practice Address - Street 1:800 GARFIELD AVE RM G-102
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5376
Practice Address - Country:US
Practice Address - Phone:304-424-4575
Practice Address - Fax:304-424-4577
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV390200000X
GUM-2407208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program