Provider Demographics
NPI:1881856516
Name:SAHIB K SHAMMAA, MD INC
Entity Type:Organization
Organization Name:SAHIB K SHAMMAA, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BUGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-466-1243
Mailing Address - Street 1:623 TEMPLE ST
Mailing Address - Street 2:POB 370
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-2230
Mailing Address - Country:US
Mailing Address - Phone:304-466-1243
Mailing Address - Fax:304-466-6050
Practice Address - Street 1:623 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-2230
Practice Address - Country:US
Practice Address - Phone:304-466-1243
Practice Address - Fax:304-466-6050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10770174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000512Medicaid
513911Medicare Oscar/Certification
WV513911Medicare Oscar/Certification
513911Medicare PIN
WVD49223Medicare UPIN
D49223Medicare UPIN
WV513911Medicare PIN