Individual
DR. NITYANANDA SANTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
911 GORMAN AVENUE, SUITE 203, ELKINS, WV 26241-3154
(304) 636-5229
(304) 636-1015
Mailing address
CENTRAL WV MEDCORP, INC., P.O. BOX 2630, ELKINS, WV 26241-2630
(304) 637-3799
(304) 637-3369
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
09853
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0127743000
—
WV
01
—
WV09853
HEALTH PLAN PROVIDER #
WV
Enumeration date
10/03/2006
Last updated
01/16/2008
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