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Individual

MRS. PRAMODA KUMARI DEVABHAKTUNI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
1 MEDICAL CENTER DRIVE, LOUIS A. JOHNSON VA MEDICAL CENTER DRIVE, CLARKSBURG, WV 26301
(304) 623-3461
(304) 623-7650
Mailing address
18 WOODCLIFF DR, FAIRMONT, WV 26554-1257
(304) 368-1124
(304) 623-7650

Taxonomy

Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
10866
MS
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
15671
WV

Other

Enumeration date
03/23/2006
Last updated
07/08/2007
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