=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285687764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHASHI R URVAL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2006
-----------------------------------------------------
Last Update Date | 06/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 58 16TH STREET
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-243-2998
-----------------------------------------------------
Fax | 304-242-4652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 58 16TH STREET
-----------------------------------------------------
City | WHEELING
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-243-2998
-----------------------------------------------------
Fax | 304-242-4652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 19969
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------