Provider Demographics
NPI:1285687764
Name:URVAL, SHASHI R (MD)
Entity Type:Individual
Prefix:
First Name:SHASHI
Middle Name:R
Last Name:URVAL
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 1:58 16TH STREET
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-2998
Mailing Address - Fax:304-242-4652
Practice Address - Street 1:58 16TH STREET
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-2998
Practice Address - Fax:304-242-4652
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19969207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143193Medicaid
WV6000501000Medicaid
H05005Medicare UPIN
WV4176891Medicare ID - Type Unspecified