Healthcare Provider Details

I. General information

NPI: 1588634430
Provider Name (Legal Business Name): SHAHID R RANA MD FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NEW HOPE RD STE 4
PRINCETON WV
24740-2287
US

IV. Provider business mailing address

608 NEW HOPE RD STE 4
PRINCETON WV
24740-2287
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-7676
  • Fax: 304-487-9032
Mailing address:
  • Phone: 304-487-7676
  • Fax: 304-487-9032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number18379
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18379
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: