Provider Demographics
NPI:1639145196
Name:SAMPATH, RAMANATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMANATHAN
Middle Name:
Last Name:SAMPATH
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 1:3100 MACCORKLE AVENUE SE
Mailing Address - Street 2:SUITE 904
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-345-4031
Mailing Address - Fax:304-344-0328
Practice Address - Street 1:3100 MACCORKLE AVENUE SE
Practice Address - Street 2:SUITE 904
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-345-4031
Practice Address - Fax:304-344-0328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV12626208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0129376001Medicaid
WV0129376001Medicaid