Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 215665-1 | NY |
Y | 2086S0120X | Pediatric Surgery | 25708 | WV |
NPI | 1346234937 |
---|---|
Provider Name | Nicholas Shorter |
First Address | Morgantown, WV 26506-1200 |
Second Address | Morgantown, WV 26506-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 08/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01458240 | (05) | NY |
C86430 | (02) | NY |