Provider Demographics
NPI:1730117326
Name:ATUL SHETTY, MD LLC
Entity Type:Organization
Organization Name:ATUL SHETTY, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ATUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-723-5400
Mailing Address - Street 1:PO BOX 2154
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-1354
Mailing Address - Country:US
Mailing Address - Phone:304-723-5400
Mailing Address - Fax:304-723-5401
Practice Address - Street 1:485 COLLIERS WAY
Practice Address - Street 2:SUITE M
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-5012
Practice Address - Country:US
Practice Address - Phone:304-723-5400
Practice Address - Fax:304-723-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0207537000Medicaid
WV9324723Medicare PIN
D26161Medicare UPIN
WV9324721Medicare PIN
PA059787Medicare PIN
OH9324722Medicare PIN
H01712Medicare UPIN