Healthcare Provider Details

I. General information

NPI: 1205000882
Provider Name (Legal Business Name): SHAWN DAVID REINERT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE HOSPITALISTS PROGRAM
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

122 PINNELL ST
RIPLEY WV
25271-9101
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5848
  • Fax: 304-388-9654
Mailing address:
  • Phone: 304-372-2731
  • Fax: 304-372-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2558
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2558
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2558
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: