Organization
INSTITUTE OF DISABILITY MEDICINE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SRINI GOVINDAN M.D. (PRESIDENT)
(304) 242-2503
Entity
Organization
Contact information
Practice address
40 MEDICAL PARK, SUITE 304, WHEELING, WV 26003-6392
(304) 242-2503
(304) 242-2682
Mailing address
40 MEDICAL PARK, SUITE 304, WHEELING, WV 26003-6392
(304) 242-2503
(304) 242-2682
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
9751
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0090961000
—
WV
01
—
9751
STATE LICENSE NUMBER
WV
Enumeration date
04/24/2007
Last updated
01/24/2008
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