Provider Demographics
NPI:1376509505
Name:SHAKESPRERE, ALFRET NORMAN (MD)
Entity Type:Individual
Prefix:
First Name:ALFRET
Middle Name:NORMAN
Last Name:SHAKESPRERE
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 1:710 SOMERSET BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4997
Mailing Address - Country:US
Mailing Address - Phone:304-728-9797
Mailing Address - Fax:304-728-9791
Practice Address - Street 1:710 SOMERSET BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4997
Practice Address - Country:US
Practice Address - Phone:304-728-9797
Practice Address - Fax:304-728-9791
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0080920000Medicaid
WV0080920000Medicaid
WV0832592Medicare ID - Type Unspecified