Provider Demographics
NPI:1265429831
Name:SHORT, YANCY S (MD)
Entity type:Individual
Prefix:DR
First Name:YANCY
Middle Name:S
Last Name:SHORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BILL BAKER WAY
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-1505
Mailing Address - Country:US
Mailing Address - Phone:304-253-2628
Mailing Address - Fax:
Practice Address - Street 1:1731 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3311
Practice Address - Country:US
Practice Address - Phone:304-255-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16555208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV004522000Medicaid
WVP01600108OtherMEDICARE RAILROAD
WV004522000Medicaid
WVWV6220AMedicare PIN