Provider Demographics
NPI:1306063219
Name:SHIN, ROBERT B (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:SHIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:600 TRACY WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25311-1262
Mailing Address - Country:US
Mailing Address - Phone:304-388-4965
Mailing Address - Fax:304-343-4850
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 602
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-388-5120
Practice Address - Fax:304-388-5125
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2015-12-18
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Provider Licenses
StateLicense IDTaxonomies
WV21092208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1808963000Medicaid
WVH14386Medicare UPIN
SH4064672Medicare PIN
WV1808963000Medicaid
4064672Medicare PIN