Healthcare Provider Details

I. General information

NPI: 1316901796
Provider Name (Legal Business Name): CHITTA RANJAN SARKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE SUITE 101
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

415 MORRIS ST SUITE 304
CHARLESTON WV
25301-1842
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-8380
  • Fax: 304-388-8388
Mailing address:
  • Phone: 304-388-7783
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20294
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: