Provider Demographics
NPI:1649477662
Name:SHAHAB, SOHRAB (MD)
Entity type:Individual
Prefix:
First Name:SOHRAB
Middle Name:
Last Name:SHAHAB
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 1:2500 FOUNDATION WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9000
Mailing Address - Country:US
Mailing Address - Phone:304-264-9202
Mailing Address - Fax:304-264-9042
Practice Address - Street 1:2000 FOUNDATION WAY STE 3200
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9199
Practice Address - Country:US
Practice Address - Phone:304-262-9400
Practice Address - Fax:304-262-9407
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22519207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00966070OtherRAIL ROAD MEDICARE
WV3810015090Medicaid
WVP00966070OtherRAIL ROAD MEDICARE
WVWV2366B987Medicare PIN