Provider Demographics
NPI:1649293309
Name:WANKO, SAM O (MD)
Entity type:Individual
Prefix:DR
First Name:SAM
Middle Name:O
Last Name:WANKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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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:
Practice Address - Street 1:BLDG 8 4TH DECK 8901 WISCONSIN AVE
Practice Address - Street 2:NATIONAL NATIONAL MEDICAL CENTER, DEPT OF ONCOLOGY
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889
Practice Address - Country:US
Practice Address - Phone:301-435-5386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058113207RH0003X
WV28106207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology