Provider Demographics
NPI:1750348389
Name:RAMANATHAN PADMANABAN MD INC
Entity type:Organization
Organization Name:RAMANATHAN PADMANABAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ORTHOPEDIC SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:RAMANATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PADMANABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-831-2525
Mailing Address - Street 1:PO BOX 330
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601
Mailing Address - Country:US
Mailing Address - Phone:304-831-2525
Mailing Address - Fax:304-831-2528
Practice Address - Street 1:20 HOSPITAL DR
Practice Address - Street 2:MEDICAL OFFICE BLDG STE 220
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601
Practice Address - Country:US
Practice Address - Phone:304-831-2525
Practice Address - Fax:304-831-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV14435207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV000702845OtherBLUE CROSS
WV0099433000Medicaid
WV5463220001Medicare NSC
WV4161081Medicare ID - Type Unspecified
B42816Medicare UPIN