Provider Demographics
NPI:1376515692
Name:BHARTI, SANJAY RANJIT (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:RANJIT
Last Name:BHARTI
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 1:1526 MILEGROUND RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3745
Mailing Address - Country:US
Mailing Address - Phone:304-296-2395
Mailing Address - Fax:304-413-0055
Practice Address - Street 1:1526 MILEGROUND RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3745
Practice Address - Country:US
Practice Address - Phone:304-296-2395
Practice Address - Fax:304-413-0055
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19609207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0015224000Medicaid
WV3810016962Medicaid
WV9387121Medicare PIN
WV0015224000Medicaid
WV0867434Medicare PIN