Provider Demographics
NPI:1700505393
Name:TRIVEDI, RAJIV HARSHADRAI
Entity Type:Individual
Prefix:
First Name:RAJIV
Middle Name:HARSHADRAI
Last Name:TRIVEDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 HARVEST RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-4872
Mailing Address - Country:US
Mailing Address - Phone:304-285-8312
Mailing Address - Fax:
Practice Address - Street 1:212 HARVEST RIDGE LN
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-4872
Practice Address - Country:US
Practice Address - Phone:304-285-8312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant