Healthcare Provider Details

I. General information

NPI: 1033739859
Provider Name (Legal Business Name): SUMITHA UDAYASHANKAR TARUR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 PENNSYLVANIA AVENUE SUITE 406
CHARLESTON WV
25302
US

IV. Provider business mailing address

830 PENNSYLVANIA AVENUE SUITE 406
CHARLESTON WV
25302
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-2238
  • Fax:
Mailing address:
  • Phone: 304-388-2238
  • Fax: 212-939-4022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number36470
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: