Provider Demographics
NPI:1740286327
Name:NAVADA, SHIV U (MD)
Entity type:Individual
Prefix:DR
First Name:SHIV
Middle Name:U
Last Name:NAVADA
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 1:527 MEDICAL PARK DRIVE
Mailing Address - Street 2:STE 107
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330
Mailing Address - Country:US
Mailing Address - Phone:304-933-3843
Mailing Address - Fax:304-933-3846
Practice Address - Street 1:527 MEDICAL PAR DRIVE
Practice Address - Street 2:STE 107
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-933-3843
Practice Address - Fax:304-933-3846
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0089964000Medicaid
WVE65600Medicare UPIN
WV0677011Medicare ID - Type Unspecified