Basic Information
Provider Information | |||||||||
NPI: | 1124084041 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NASHED | ||||||||
FirstName: | TRISHA | ||||||||
MiddleName: | BANSAL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 220 CAMPUS BLVD STE 100 | ||||||||
Address2: |   | ||||||||
City: | WINCHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 226012896 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5405365100 | ||||||||
FaxNumber: | 5405360235 | ||||||||
Practice Location | |||||||||
Address1: | 1880 AMHERST ST | ||||||||
Address2: | SUITE 100 AND SUITE 200 | ||||||||
City: | WINCHESTER | ||||||||
State: | VA | ||||||||
PostalCode: | 226012873 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5406620306 | ||||||||
FaxNumber: | 8552642066 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 04/21/2006 | ||||||||
LastUpdateDate: | 09/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21252 | WV | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RC0000X | 0101058035 | VA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 000875693 | 01 | WV | BLUE SHIELD GROUP # | OTHER | 3810003817 | 01 | WV | WV MEDICAID GROUP | OTHER | 2119646 | 01 |   | MAMSI PROFESSIONAL | OTHER | 3003798000 | 05 | WV |   | MEDICAID | 550941601 | 01 | MD | MD MEDICAID GRP-WV | OTHER | 65465 | 01 |   | SENTARA PROFESSIONAL | OTHER | 304023200 | 05 | MD |   | MEDICAID | 550941600 | 01 | MD | MD MEDICAID GRP-VA | OTHER | P00656344 | 01 |   | RAILROAD MEDICARE | OTHER | 001717445 | 01 | WV | BLUE SHIELD | OTHER | 010007411 | 05 | VA |   | MEDICAID | 9371521 | 01 | WV | WV MEDICARE GRP-NEW | OTHER | 289027 | 01 |   | ANTHEM PROFESSIONAL | OTHER |