Basic Information
| Provider Information | |||||||||
| NPI: | 1124008917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAIN | ||||||||
| FirstName: | RAJIV | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 88 | ||||||||
| Address2: | 5 E ALVON ROAD SUITE 7 | ||||||||
| City: | WHITE SULPHUR SPRINGS | ||||||||
| State: | WV | ||||||||
| PostalCode: | 249862373 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045365030 | ||||||||
| FaxNumber: | 3045365031 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 1ST AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257021241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043997484 | ||||||||
| FaxNumber: | 3043997579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 03/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1666 | WV | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34.007367 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3002051000 | 05 | WV | MEDICAID | 1057639 | 01 | COMPNET | OTHER | 2246724 | 05 | OH | MEDICAID | 63154600 | 01 | WV | BLACK LUNG | OTHER | 3232099 | 01 | WV | CIGNA | OTHER | 64040496 | 05 | KY | MEDICAID |