1902026826 NPI number — SUSHIL K MEHROTRA MD INC

Table of content: SARAH JEAN COYLE RD, LDN (NPI 1194561399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902026826 NPI number — SUSHIL K MEHROTRA MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSHIL K MEHROTRA MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902026826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2101 JACOB ST
Provider Second Line Business Mailing Address:
STE 302
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-232-1122
Provider Business Mailing Address Fax Number:
304-234-1873

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNESVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43713-1098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-425-5183
Provider Business Practice Location Address Fax Number:
304-234-1873
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEHROTRA
Authorized Official First Name:
SUSHIL
Authorized Official Middle Name:
KUMAR
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
304-232-1122

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4000018000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2118069 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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