Healthcare Provider Details

I. General information

NPI: 1194885236
Provider Name (Legal Business Name): VALLEY INTERNAL MEDICINE,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 02/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WELDAY AVE
WINTERSVILLE OH
43953-3779
US

IV. Provider business mailing address

PO BOX 3169
WEIRTON WV
26062-7169
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-5770
  • Fax: 740-264-5780
Mailing address:
  • Phone: 740-264-5770
  • Fax: 740-264-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ATUL P SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 740-264-5770