Healthcare Provider Details

I. General information

NPI: 1770342917
Provider Name (Legal Business Name): SANDEEP KUMAR PATNAIK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 HOSPITAL RD
WHITESBURG KY
41858-7627
US

IV. Provider business mailing address

306 CAMBRIDGE POINTE
CHARLESTON WV
25309-8596
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-3500
  • Fax:
Mailing address:
  • Phone: 304-389-8649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: