Individual
BALAKRISHNAN SRIDHARAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3200 MACCORKLE AVE SE, HOSPITALISTS PROGRAM, CHARLESTON, WV 25304-1227
(304) 388-5848
(304) 388-9654
Mailing address
415 MORRIS ST, SUITE 304, CHARLESTON, WV 25301-1842
(304) 388-7782
(304) 388-7788
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19265
WV
208M00000X
Hospitalist Physician
19265
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1809060000
—
WV
05
—
3810016539
—
WV
01
—
P00824219
RAILROAD MEDICARE
WV
Enumeration date
11/02/2005
Last updated
02/27/2013
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