Provider Demographics
NPI:1114014958
Name:BHAVSAR, SHASHIKANT BHAILAI (MD)
Entity Type:Individual
Prefix:
First Name:SHASHIKANT
Middle Name:BHAILAI
Last Name:BHAVSAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37456 COAL RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25209-0217
Mailing Address - Country:US
Mailing Address - Phone:304-854-1323
Mailing Address - Fax:304-854-1021
Practice Address - Street 1:26 TRINTY LANE
Practice Address - Street 2:
Practice Address - City:OCEANA
Practice Address - State:WV
Practice Address - Zip Code:24870-0400
Practice Address - Country:US
Practice Address - Phone:304-682-6246
Practice Address - Fax:304-682-4543
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVB08302Medicare UPIN