Healthcare Provider Details

I. General information

NPI: 1306079579
Provider Name (Legal Business Name): SANJOY K. NATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 12/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVENUE SE HOSPITALIST PROGRAM
CHARLESTON WV
25304
US

IV. Provider business mailing address

415 MORRIS STREET SUITE 304
CHARLESTON WV
25301
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5848
  • Fax: 304-388-9654
Mailing address:
  • Phone: 304-388-7782
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23700
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number23700
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: