Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 29682 | WV |
NPI | 1497168595 |
---|---|
Provider Name | Santosh Nagaraju |
First Address | Charleston, WV 25301-1326 |
Second Address | Charleston, WV 25301-1326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2014 |
Last Update Date | 04/12/2020 |