Provider Demographics
NPI:1962532549
Name:SANJAY BHARTI MD PLLC
Entity type:Organization
Organization Name:SANJAY BHARTI MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS STRATEGY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RAMA SUBBA RAO
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:KADIYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-363-3714
Mailing Address - Street 1:51 SOUTHLAND DR STE 2400
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2247
Mailing Address - Country:US
Mailing Address - Phone:304-363-3714
Mailing Address - Fax:304-363-6850
Practice Address - Street 1:51 SOUTHLAND DR STE 2400
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2247
Practice Address - Country:US
Practice Address - Phone:304-363-3714
Practice Address - Fax:304-363-6850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV110236001OtherRR MC
WV000332087OtherMS BCBS
WV3810016962Medicaid
WV0015224000Medicaid
WV5622758OtherAETNA
WV001811060OtherBS PAY TO NUMBER
WV5622758OtherAETNA
WV0015224000Medicaid