1588705107 NPI number — DR. SUNILA MEHROTRA M.D. F.A.A.P.

Table of content: WILMA C GAUTHIER (NPI 1578727764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588705107 NPI number — DR. SUNILA MEHROTRA M.D. F.A.A.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEHROTRA
Provider First Name:
SUNILA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D. F.A.A.P.
Provider Gender Code:
F

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:
1588705107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 EOFF ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26003-3823
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-234-8663
Provider Business Mailing Address Fax Number:
304-234-8960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2101 JACOB ST STE 602
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELING
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26003-3844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-231-3853
Provider Business Practice Location Address Fax Number:
304-231-3854
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  13330 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3810002613 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




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