Basic Information
| Provider Information | |||||||||
| NPI: | 1225022775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | NIK | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 779 | ||||||||
| Address2: | |||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261020779 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044227555 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Practice Location | |||||||||
| Address1: | 705 GARFIELD AVE | ||||||||
| Address2: | STE 220 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 26101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044227555 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2005 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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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 | 207RH0003X | 11970 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.