Provider Demographics
NPI:1710947544
Name:DEOL, PRABHJOT SINGH (MD)
Entity Type:Individual
Prefix:
First Name:PRABHJOT
Middle Name:SINGH
Last Name:DEOL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
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:304-723-4264
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:304-723-4264
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV192942084P0800X
OH35-0759722084P0800X
PAMD046128L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0116578000Medicaid
OH2113564Medicaid
WVDE0864142Medicare ID - Type UnspecifiedOH MEDICARE
WV0116578000Medicaid
OH2113564Medicaid