Provider Demographics
NPI:1902026826
Name:SUSHIL K MEHROTRA MD INC
Entity Type:Organization
Organization Name:SUSHIL K MEHROTRA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSHIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MEHROTRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-232-1122
Mailing Address - Street 1:2101 JACOB ST
Mailing Address - Street 2:STE 302
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3800
Mailing Address - Country:US
Mailing Address - Phone:304-232-1122
Mailing Address - Fax:304-234-1873
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1098
Practice Address - Country:US
Practice Address - Phone:740-425-5183
Practice Address - Fax:304-234-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4000018000Medicaid
OH2118069Medicaid
OH2118069Medicaid
WV4000018000Medicaid