Healthcare Provider Details

I. General information

NPI: 1205085651
Provider Name (Legal Business Name): SHASHANK PONUGOTI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER DRIVE
MORGANTOWN WV
26505
US

IV. Provider business mailing address

PO BOX 88
WHITE SULPHUR SPRINGS WV
24986-0088
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-1964
  • Fax:
Mailing address:
  • Phone: 304-536-5030
  • Fax: 304-536-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23711
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number53981
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: