Healthcare Provider Details

I. General information

NPI: 1013534999
Provider Name (Legal Business Name): SIDDHARTH CHOPRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MAC CORKLE AVE, SE
CHARLESTON WV
25304
US

IV. Provider business mailing address

3110 MAC CORKLE AVE, SE
CHARLESTON WV
25304
US

V. Phone/Fax

Practice location:
  • Phone: 304-351-2867
  • Fax:
Mailing address:
  • Phone: 248-858-3234
  • Fax: 248-858-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number340816
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number1632
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number340816
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number1632
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1632
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number340816
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: