Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 17712 | WV |
NPI | 1043274830 |
---|---|
Provider Name | Mohamad Riad Sankari |
First Address | Montgomery, WV 25136-2117 |
Second Address | Montgomery, WV 25136-2117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 28/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0077407000 | (05) | WV |
F91384 | (02) |