Provider Demographics
NPI:1972573780
Name:MEHROTRA, SUSHIL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:KUMAR
Last Name:MEHROTRA
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 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-8960
Practice Address - Street 1:2101 JACOB ST
Practice Address - Street 2:SUITE 302
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-232-1122
Practice Address - Fax:304-234-1864
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047846207RH0000X
WV13159207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0083694000Medicaid
OH0492668Medicaid
A72644Medicare UPIN
OH0492668Medicaid
WV0083694000Medicaid