Provider Demographics
NPI:1952347379
Name:JAMIE, SHAHROOZ SAHEB (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAHROOZ
Middle Name:SAHEB
Last Name:JAMIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S
Other - Middle Name:S
Other - Last Name:JAMIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:43 MAIN ST
Mailing Address - Street 2:PO BOX 10
Mailing Address - City:CLAY
Mailing Address - State:WV
Mailing Address - Zip Code:25043
Mailing Address - Country:US
Mailing Address - Phone:304-587-2636
Mailing Address - Fax:304-587-4789
Practice Address - Street 1:43 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043
Practice Address - Country:US
Practice Address - Phone:304-587-2636
Practice Address - Fax:304-587-4789
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10485208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055781000Medicaid
WA0699802OtherFUNDS
D49241Medicare UPIN
WV0055781000Medicaid