Individual
VIJAYKUMAR R PHADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
496 CHERRY ST, BLDG C STE A, BLUEFIELD, WV 24701-3304
(304) 327-7476
(304) 327-7476
Mailing address
PO BOX 1553, BLUEFIELD, WV 24701
(304) 327-7476
(304) 327-7476
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
0101037661
VA
208600000X
Surgery Physician
Primary
12519
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0218227000
—
WV
Enumeration date
04/20/2006
Last updated
01/02/2008
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