Provider Demographics
NPI:1760615710
Name:SUNKAVALLI, RAJA GOPAL (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA GOPAL
Middle Name:
Last Name:SUNKAVALLI
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 1:2500 FOUNDATION WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-9000
Mailing Address - Country:US
Mailing Address - Phone:304-264-9202
Mailing Address - Fax:304-264-9042
Practice Address - Street 1:2000 PROFESSIONAL CT STE C
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8803
Practice Address - Country:US
Practice Address - Phone:304-263-8853
Practice Address - Fax:304-263-6178
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055068208000000X
GA66329208000000X
WV26089208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810028050Medicaid
WVWV4760B987OtherMEDICARE PTAN