Provider Demographics
NPI:1801826391
Name:SHAH, MIAN WILAYAT (MD)
Entity Type:Individual
Prefix:
First Name:MIAN
Middle Name:WILAYAT
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 NEW HOPE RD
Mailing Address - Street 2:STE 207
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2264
Mailing Address - Country:US
Mailing Address - Phone:304-425-3761
Mailing Address - Fax:304-487-3654
Practice Address - Street 1:508 NEW HOPE RD
Practice Address - Street 2:STE 207
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2264
Practice Address - Country:US
Practice Address - Phone:304-425-3761
Practice Address - Fax:304-487-3654
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV09970208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0130754000Medicaid
C34943Medicare UPIN
WV0130754000Medicaid