Provider Demographics
NPI:1588705107
Name:MEHROTRA, SUNILA (MD FAAP)
Entity type:Individual
Prefix:DR
First Name:SUNILA
Middle Name:
Last Name:MEHROTRA
Suffix:
Gender:F
Credentials:MD FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-3823
Mailing Address - Country:US
Mailing Address - Phone:304-234-8663
Mailing Address - Fax:304-234-8960
Practice Address - Street 1:2101 JACOB ST STE 602
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3844
Practice Address - Country:US
Practice Address - Phone:304-231-3853
Practice Address - Fax:304-231-3854
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV133302080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002613Medicaid