Organization
MARION LUNG CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PRASAD V DEVABHAKTUNI MD (OWNER)
(304) 363-7773
Entity
Organization
Contact information
Practice address
1325 LOCUST AVE, SUITE 35, FAIRMONT, WV 26554-1435
(304) 363-7773
(304) 363-7773
Mailing address
1325 LOCUST AVE, SUITE 35, FAIRMONT, WV 26554-1435
(304) 363-7773
(304) 363-7773
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009095000
—
WV
01
—
001710138
BCBS GROUP NUMBER
WV
Enumeration date
01/04/2007
Last updated
08/06/2008
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