Pramoda Kumari Devabhaktuni, M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

15671 Issued in WV

Practice address

1 Medical Center Drive
Louis a. Johnson VA Medical Center Drive
Clarksburg, WV 26301

Phone

(304) 623-3461

Fax

(304) 623-7650

NPI assigned

Mar 23, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770542052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 WOODCLIFF DR",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265541257",
            "telephone_number": "304-368-1124",
            "fax_number": "304-623-7650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DRIVE",
            "address_2": "LOUIS A. JOHNSON VA MEDICAL CENTER DRIVE",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "26301",
            "telephone_number": "304-623-3461",
            "fax_number": "304-623-7650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVABHAKTUNI",
        "first_name": "PRAMODA",
        "middle_name": "KUMARI",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "WV",
            "license": "15671",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "MS",
            "license": "10866",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel J Demarino
• Belinda Ann Demastus
• Elizabeth Ann Dempsey, MSW
• Eric Dennison
• Jennifer Destito, OTR
• Shawna Lindsey Deverick
• Kristie Devlin-McConnell
• Tammy J Dewitt, LSW
• Charles Dick
• Cindy Dick

• Geriatric Medicine (Internal Medicine) Physician in Clarksburg, WV
• Providers in Clarksburg, WV by specialty
• Geriatric Medicine (Internal Medicine) Physician in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.