Organization
VIJAYKUMAR R PHADE MD PC
Active
Other names
Vijaykumar R. Phade MD
Organization subpart
No
Provider details
NPI number
Authorized official
VIJAYKUMAR R PHADE M.D. (PRESIDENT)
(304) 327-7476
Entity
Organization
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 24701-1553
(304) 327-7476
(304) 327-7476
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
12519
WV
2086S0129X
Vascular Surgery Physician
12519
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007394322
—
VA
05
—
0128227000
—
WV
01
—
020000431
RAILROAD MEDICARE
WV
Enumeration date
10/19/2007
Last updated
07/16/2008
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