Healthcare Provider Details

I. General information

NPI: 1013947241
Provider Name (Legal Business Name): SAMAR RYIAD SANKARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1097 FLEDDERJOHN RD
CHARLESTON WV
25314-4208
US

IV. Provider business mailing address

4605 MACCORKLE AVE SW
SOUTH CHARLESTON WV
25309-1311
US

V. Phone/Fax

Practice location:
  • Phone: 304-720-1963
  • Fax: 304-720-1966
Mailing address:
  • Phone: 304-414-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18512
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number18512
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: