Organization
VAIDHYAA PAEDIATRIX, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MUTHUMANIMOLI SIVAKUMARAN MD (PRESIDENT)
(304) 269-0865
Entity
Organization
Contact information
Practice address
29 HOSPITAL PLZ, SUITE A, WESTON, WV 26452-8470
(304) 269-0865
(304) 269-0868
Mailing address
PO BOX 748, WESTON, WV 26452-0748
(304) 269-0865
(304) 269-0868
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
18760B
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110583000
—
WV
Enumeration date
11/03/2006
Last updated
04/20/2008
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