Provider Demographics
NPI:1194725580
Name:SHAALAN, M. BASHAR (MD)
Entity type:Individual
Prefix:DR
First Name:M.
Middle Name:BASHAR
Last Name:SHAALAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3200 MACCORKLE AVE SE
Mailing Address - Street 2:STE B16
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1227
Mailing Address - Country:US
Mailing Address - Phone:304-388-7782
Mailing Address - Fax:304-388-7788
Practice Address - Street 1:3200 MACCORKLE AVENUE SE
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5848
Practice Address - Fax:304-388-9654
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2017-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WV20912208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV7753698OtherAETNA
WV001766463OtherMS BCBS
WV3810006535Medicaid
WVI33069Medicare UPIN
WV001766463OtherMS BCBS
WV7334531Medicare PIN
SH7334532Medicare PIN