Provider Demographics
NPI:1659685246
Name:SURATKAL V SHENOY MD PC
Entity Type:Organization
Organization Name:SURATKAL V SHENOY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:SURATKAL
Authorized Official - Middle Name:V
Authorized Official - Last Name:SHENOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-788-6566
Mailing Address - Street 1:PO BOX 929
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-0929
Mailing Address - Country:US
Mailing Address - Phone:304-788-6566
Mailing Address - Fax:301-786-7050
Practice Address - Street 1:RT 220 SOUTH AND STAGGS LANE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726
Practice Address - Country:US
Practice Address - Phone:304-788-6566
Practice Address - Fax:301-786-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12745208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0498991Medicare PIN