Provider Demographics
NPI:1487645073
Name:SHETH, ASHISH (MD)
Entity type:Individual
Prefix:DR
First Name:ASHISH
Middle Name:
Last Name:SHETH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:924 CROSS LANES DR
Mailing Address - Street 2:WV PRIMARY CARE
Mailing Address - City:CROSS LANES
Mailing Address - State:WV
Mailing Address - Zip Code:25313-1315
Mailing Address - Country:US
Mailing Address - Phone:304-776-9872
Mailing Address - Fax:304-204-2385
Practice Address - Street 1:924 CROSS LANES DR
Practice Address - Street 2:CROSS LANES INTERNAL MEDICINE GROUP INC
Practice Address - City:CROSS LANES
Practice Address - State:WV
Practice Address - Zip Code:25313-1315
Practice Address - Country:US
Practice Address - Phone:304-776-9872
Practice Address - Fax:304-204-2385
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-12-20
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Provider Licenses
StateLicense IDTaxonomies
WV19078207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0080729000Medicaid
WV0080729000Medicaid