Provider Demographics
NPI:1558685172
Name:SOLTANI, SANAZ NICKY (MD)
Entity Type:Individual
Prefix:
First Name:SANAZ
Middle Name:NICKY
Last Name:SOLTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FOUNDATION WAY STE 2600
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9197
Mailing Address - Country:US
Mailing Address - Phone:304-267-1944
Mailing Address - Fax:304-267-1946
Practice Address - Street 1:2000 FOUNDATION WAY STE 2600
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9197
Practice Address - Country:US
Practice Address - Phone:304-267-1944
Practice Address - Fax:304-267-1946
Is Sole Proprietor?:No
Enumeration Date:2010-03-25
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV28100207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program