Provider Demographics
NPI:1396741880
Name:JOGENPALLY, NARENDER RAO (MD)
Entity type:Individual
Prefix:DR
First Name:NARENDER
Middle Name:RAO
Last Name:JOGENPALLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 MACCORKLE AVE SW
Mailing Address - Street 2:
Mailing Address - City:SOUTH CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25309-1311
Mailing Address - Country:US
Mailing Address - Phone:304-414-4800
Mailing Address - Fax:
Practice Address - Street 1:401 DIVISION ST STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-766-4350
Practice Address - Fax:304-766-4355
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18973207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3810024049OtherGROUP MEDICAID
WVB441OtherGROUP MEDICARE
WV0080869000Medicaid
WV830004656OtherRAILROAD MEDICARE
WVG32266Medicare UPIN
WV0080869000Medicaid