Provider Demographics
NPI:1699701094
Name:SANDHU, UJJAL (MD)
Entity type:Individual
Prefix:
First Name:UJJAL
Middle Name:
Last Name:SANDHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 GREAT TEAYS BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SCOTT DEPOT
Mailing Address - State:WV
Mailing Address - Zip Code:25560-9816
Mailing Address - Country:US
Mailing Address - Phone:304-757-6999
Mailing Address - Fax:304-757-3252
Practice Address - Street 1:116 HILLS PLZ
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25387-2438
Practice Address - Country:US
Practice Address - Phone:304-720-4466
Practice Address - Fax:304-720-4821
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09449207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0094129000Medicaid
WV4242419OtherAETNA
WV000089575OtherMS BCBS
2030634Medicare PIN
2030636Medicare PIN
2030631Medicare PIN
WV000089575OtherMS BCBS
2030633Medicare PIN
2030639Medicare PIN
WV0094129000Medicaid
2030635Medicare PIN
2033981Medicare PIN
2033982Medicare PIN
2030637Medicare PIN
2030632Medicare PIN
WV4242419OtherAETNA