Healthcare Provider Details

I. General information

NPI: 1316001928
Provider Name (Legal Business Name): R SAMPATH MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVENUE SE SUITE 904
CHARLESTON WV
25304
US

IV. Provider business mailing address

3100 MACCORKLE AVENUE SE SUITE 904
CHARLESTON WV
25304
US

V. Phone/Fax

Practice location:
  • Phone: 304-345-4031
  • Fax: 304-344-0328
Mailing address:
  • Phone: 304-345-4031
  • Fax: 304-344-0328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: RAMANATHAN SAMPATH
Title or Position: PRESIDENT
Credential: MD
Phone: 304-345-4031