Provider Demographics
NPI:1659718740
Name:PRABHJOT S DEOL, M.D. PLLC
Entity Type:Organization
Organization Name:PRABHJOT S DEOL, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-723-4260
Mailing Address - Street 1:485 COLLIERS WAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-5012
Mailing Address - Country:US
Mailing Address - Phone:304-723-4260
Mailing Address - Fax:
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:SUITE C
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5012
Practice Address - Country:US
Practice Address - Phone:304-723-4260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty