=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205085651
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHASHANK PONUGOTI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2008
-----------------------------------------------------
Last Update Date | 10/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 MEDICAL CENTER DRIVE
-----------------------------------------------------
City | MORGANTOWN
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-293-1964
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 88
-----------------------------------------------------
City | WHITE SULPHUR SPRINGS
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 24986-0088
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-536-5030
-----------------------------------------------------
Fax | 304-536-5031
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number | 53981
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 23711
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------