Provider Demographics
NPI:1568400976
Name:GONDALIA, BHAILAL GOKALBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:BHAILAL
Middle Name:GOKALBHAI
Last Name:GONDALIA
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 1:600 18TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3231
Mailing Address - Country:US
Mailing Address - Phone:304-424-4618
Mailing Address - Fax:304-424-4846
Practice Address - Street 1:600 18TH ST STE 111
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3236
Practice Address - Country:US
Practice Address - Phone:304-424-4618
Practice Address - Fax:304-424-4846
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16592207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0693121OtherMEDICARE ID
OH0827770Medicaid
WV0073853000Medicaid
WV161461800OtherWV WORKERS COMP
OH550708689-00OtherOH WORKERS COMP
WV0693122OtherMEDICARE ID