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General NPI Number Information
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NPI Number | 1649293309
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Entity Type | Individual
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Provider Name | SAM O WANKO MD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | BLDG 8 4TH DECK 8901 WISCONSIN AVE NATIONAL NATIONAL MEDICAL CENTER, DEPT OF ONCOLOGY
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City | BETHESDA
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State | MD
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Zip | 20889
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Country | US
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Telephone | 301-435-5386
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 FOUNDATION WAY STE 2600
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City | MARTINSBURG
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State | WV
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Zip | 25401-9197
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Country | US
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Telephone | 304-267-1944
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 0101058113
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 28106
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License Number State | WV
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