Provider Demographics
NPI:1407840978
Name:JAMES-HART, TYSHAUN M (MD)
Entity Type:Individual
Prefix:DR
First Name:TYSHAUN
Middle Name:M
Last Name:JAMES-HART
Suffix:
Gender:F
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:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-0009
Mailing Address - Country:US
Mailing Address - Phone:304-466-2944
Mailing Address - Fax:304-466-2943
Practice Address - Street 1:250 STANAFORD RD
Practice Address - Street 2:SUITE 105
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3140
Practice Address - Country:US
Practice Address - Phone:304-254-2667
Practice Address - Fax:304-254-2732
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV216162086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001723603OtherMOUNTAIN STATE BLUE CROSS
WV3810001300Medicaid
WV000056944COtherHUMANA
WVP00380544OtherRAILROAD MEDICARE PIN #
WV000056944COtherHUMANA
WVG55459Medicare UPIN