Provider Demographics
NPI:1568471480
Name:OGERSHOK, PAUL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:OGERSHOK
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 1:125 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2665
Mailing Address - Country:US
Mailing Address - Phone:304-624-7200
Mailing Address - Fax:304-554-0444
Practice Address - Street 1:1150 7TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-1660
Practice Address - Country:US
Practice Address - Phone:724-627-2395
Practice Address - Fax:724-627-2610
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060665L207K00000X
WV18887207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016897100001Medicaid
WV3810006540Medicaid
WV0081679000Medicaid
PA001689710Medicaid
PA0016897100001Medicaid
G81377Medicare UPIN
PA001689710Medicaid
WV3810006540Medicaid