Provider Demographics
NPI:1649382227
Name:HOPKINS, ERIC SHANE (MD RVT FACS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:SHANE
Last Name:HOPKINS
Suffix:
Gender:M
Credentials:MD RVT FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 12TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2352
Mailing Address - Country:US
Mailing Address - Phone:304-431-5168
Mailing Address - Fax:
Practice Address - Street 1:201 12TH ST EXTENSION
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-0201
Practice Address - Country:US
Practice Address - Phone:304-425-1852
Practice Address - Fax:304-431-3756
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20329208600000X, 2086S0129X
VA0101237879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010005779Medicaid
WV2002286000Medicaid
H32288Medicare UPIN
WV2002286000Medicaid
VAVAA102558Medicare PIN