Provider Demographics
NPI:1912049552
Name:MADHU N DHARAWAT MD
Entity Type:Organization
Organization Name:MADHU N DHARAWAT MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR CARDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MADHU
Authorized Official - Middle Name:N
Authorized Official - Last Name:DHARAWAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-845-0100
Mailing Address - Street 1:426 8TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1451
Mailing Address - Country:US
Mailing Address - Phone:304-845-0100
Mailing Address - Fax:304-845-9879
Practice Address - Street 1:426 8TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1451
Practice Address - Country:US
Practice Address - Phone:304-845-0100
Practice Address - Fax:304-845-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21010207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV9341351Medicare ID - Type UnspecifiedGROUP NUMBER