Provider Demographics
NPI:1861480378
Name:O'SHEA, HEATHER ANN (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WHEELING AVE
Mailing Address - Street 2:REAR A
Mailing Address - City:GLEN DALE
Mailing Address - State:WV
Mailing Address - Zip Code:26038-1736
Mailing Address - Country:US
Mailing Address - Phone:304-845-5700
Mailing Address - Fax:304-845-7400
Practice Address - Street 1:1307 WHEELING AVE
Practice Address - Street 2:REAR A
Practice Address - City:GLEN DALE
Practice Address - State:WV
Practice Address - Zip Code:26038-1736
Practice Address - Country:US
Practice Address - Phone:304-845-5700
Practice Address - Fax:304-845-7400
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVO4067291Medicare ID - Type Unspecified
WVH54856Medicare UPIN