Provider Demographics
NPI:1801098835
Name:PANHANDLE GASTROENTEROLOGY, PLLC
Entity type:Organization
Organization Name:PANHANDLE GASTROENTEROLOGY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAHIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-260-0160
Mailing Address - Street 1:2000 FOUNDATION WAY
Mailing Address - Street 2:SUITE 3500
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9583
Mailing Address - Country:US
Mailing Address - Phone:304-260-0160
Mailing Address - Fax:304-260-0162
Practice Address - Street 1:2000 FOUNDATION WAY
Practice Address - Street 2:SUITE 3500
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9583
Practice Address - Country:US
Practice Address - Phone:304-260-0160
Practice Address - Fax:304-260-0162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2108207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001767978OtherBLUE CROSS BLUE SHEILD
WV3810003032Medicaid
WV001767952OtherBLUE CROSS BLUE SHIELD
I38702Medicare UPIN
WV001767978OtherBLUE CROSS BLUE SHEILD
RA4166761Medicare ID - Type Unspecified