Provider Demographics
NPI:1770562605
Name:SHROFF, MAHESH B (MD)
Entity type:Individual
Prefix:
First Name:MAHESH
Middle Name:B
Last Name:SHROFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:390 CARSKADON LANE
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726
Mailing Address - Country:US
Mailing Address - Phone:304-788-6655
Mailing Address - Fax:304-788-6082
Practice Address - Street 1:390 CARSKADON LANE
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726
Practice Address - Country:US
Practice Address - Phone:304-788-6655
Practice Address - Fax:304-788-6082
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV16193207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0072995000Medicaid
E13328Medicare UPIN
WVSH0675061Medicare ID - Type Unspecified