Marion Lung Clinic

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

Legal business name

MARION LUNG CLINIC

Practice address

1325 Locust Ave
Suite 35
Fairmont, WV 26554-1435

Phone

(304) 363-7773

Fax

(304) 363-7773

NPI assigned

Jan 4, 2007

Last updated

Aug 6, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Prasad V Devabhaktuni, MDNPI 1417027103

Title

Owner

Phone

(304) 363-7773

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Prasad Venkata Devabhaktuni, M.D.

  • Pulmonary Disease Physician
  • Fairmont, WV
  • NPI 1417027103
  Authorized official Same address or phone
• Stephen Joseph Cromwell, P.A.-C.

  • Physician Assistant
  • Clarksburg, WV
  • NPI 1699735779
  NPD (past)
• Mohammad Tariq, MD

  • Pulmonary Disease Physician
  • Kokomo, IN
  • NPI 1386792521
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217980800000",
    "number": "1053468900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 LOCUST AVE",
            "address_2": "SUITE 35",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541435",
            "telephone_number": "304-363-7773",
            "fax_number": "304-363-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 LOCUST AVE",
            "address_2": "SUITE 35",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541435",
            "telephone_number": "304-363-7773",
            "fax_number": "304-363-7773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARION LUNG CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2008-08-06",
        "status": "A",
        "authorized_official_last_name": "DEVABHAKTUNI",
        "authorized_official_first_name": "PRASAD",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-363-7773",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "001710138",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0009095000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marion County Health Department Home Health Service
• Marion County Rescue Squad Inc
• Marion County Senior Citizens
• Marion County Senior Citizens, Inc.
• Marion County Senior Citizens, Inc.
• Marion Medical Associates Inc.
• Marion Moreland LLC (Trinitas A Part of Integrated Hearts)
• Marion Surgical Associates, Inc
• Market Street Dental Studio
• Kendra Dawn Markley

• Pulmonary Disease Physician in Fairmont, WV
• Providers in Fairmont, WV by specialty
• Pulmonary Disease Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.