Provider Demographics
NPI:1710005970
Name:SHATS, DANIEL (MD, MBA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SHATS
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6826
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-0921
Mailing Address - Country:US
Mailing Address - Phone:304-242-7106
Mailing Address - Fax:
Practice Address - Street 1:3000 GUERNSEY ST FL 2
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1540
Practice Address - Country:US
Practice Address - Phone:740-633-4765
Practice Address - Fax:740-633-6450
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA-85003207R00000X, 390200000X
PAMD440935207R00000X
OH35098773207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV99999Medicaid
OH99999Medicaid
WV99999Medicare PIN
OH99999Medicaid