# PRINCETON UROLOGICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821027905
- **Authorized official:** MIAN W SHAH MD (PRESIDENT)
- **Authorized official phone:** (304) 425-3761

## Contact information

- **Practice address:** 508 NEW HOPE RD, STE 207, PRINCETON, WV 24740-2264
- **Practice address phone:** (304) 425-3761
- **Practice address fax:** (304) 487-3654
- **Mailing address:** 508 NEW HOPE RD, STE 207, PRINCETON, WV 24740-2264
- **Mailing address phone:** (304) 425-3761
- **Mailing address fax:** (304) 487-3654

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/01/2006
- **Last updated:** 03/13/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0130754000 | — | WV |