1962532549 NPI number — SANJAY BHARTI MD PLLC

Table of content: (NPI 1962532549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962532549 NPI number — SANJAY BHARTI MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANJAY BHARTI MD PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962532549
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
51 SOUTHLAND DR STE 2400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRMONT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26554-2247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-363-3714
Provider Business Mailing Address Fax Number:
304-363-6850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
51 SOUTHLAND DR STE 2400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRMONT
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26554-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-363-3714
Provider Business Practice Location Address Fax Number:
304-363-6850
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KADIYALA
Authorized Official First Name:
RAMA SUBBA RAO
Authorized Official Middle Name:
RAO
Authorized Official Title or Position:
BUSINESS STRATEGY MANAGER
Authorized Official Telephone Number:
304-363-3714

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  19609 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110236001 . This is a "RR MC" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 000332087 . This is a "MS BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 3810016962 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0015224000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5622758 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 001811060 . This is a "BS PAY TO NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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