Provider Demographics
NPI:1841872520
Name:NETHAGANI, SANJANA (MD)
Entity type:Individual
Prefix:DR
First Name:SANJANA
Middle Name:
Last Name:NETHAGANI
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 1:64 MEDICAL CENTER DR FL 3
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-3409
Mailing Address - Country:US
Mailing Address - Phone:304-598-4000
Mailing Address - Fax:304-598-4161
Practice Address - Street 1:64 MEDICAL CENTER DR FL 3
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3409
Practice Address - Country:US
Practice Address - Phone:304-598-4000
Practice Address - Fax:304-598-4161
Is Sole Proprietor?:No
Enumeration Date:2021-04-22
Last Update Date:2024-05-23
Deactivation Date:2022-02-24
Deactivation Code:
Reactivation Date:2022-03-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program