Individual
DR. PRASAD VENKATA DEVABHAKTUNI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14 E GRAFTON RD, SUITE C, FAIRMONT, WV 26554-4465
(304) 363-7773
(304) 363-7773
Mailing address
14 E GRAFTON RD, SUITE C, FAIRMONT, WV 26554-4465
(304) 363-7773
(304) 363-7773
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
15587
WV
207RP1001X
Pulmonary Disease Physician
Primary
15587
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0009095000
—
WV
05
—
0071632000
—
WV
Enumeration date
11/09/2006
Last updated
09/25/2012
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