Provider Demographics
NPI:1184642829
Name:PROFESSIONAL ENDOCRINOLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:PROFESSIONAL ENDOCRINOLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICIAN, MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-720-1963
Mailing Address - Street 1:PO BOX 3466
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25334-3466
Mailing Address - Country:US
Mailing Address - Phone:304-720-1963
Mailing Address - Fax:304-720-1966
Practice Address - Street 1:331 LAIDLEY ST STE 507
Practice Address - Street 2:PROFESSIONAL ENDOCRINOLOGY ASSOCIATES, PLLC
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1682
Practice Address - Country:US
Practice Address - Phone:304-720-1963
Practice Address - Fax:304-720-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004642Medicaid
WV001803459OtherBCBS GROUP
WVDE7709OtherRR MEDICARE
WVDE7709OtherRR MEDICARE