Provider Demographics
NPI:1588634430
Name:RANA, SHAHID R (MD FACC)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:R
Last Name:RANA
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NEW HOPE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2287
Mailing Address - Country:US
Mailing Address - Phone:304-487-7676
Mailing Address - Fax:304-487-9032
Practice Address - Street 1:608 NEW HOPE RD STE 4
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2287
Practice Address - Country:US
Practice Address - Phone:304-487-7676
Practice Address - Fax:304-487-9032
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18379207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0086326000Medicaid
1504139OtherUMWA HIR
WV001721883OtherBLUE CROSS
1504139OtherUMWA HIR
WVRA0796441Medicare ID - Type Unspecified