Individual
SANGEETA MANDAPAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3100 MACCORKLE AVE SE STE 101, CHARLESTON, WV 25304-1215
(304) 388-8200
(304) 388-7010
Mailing address
3200 MACCORKLE AVENUE SE, OUTPATIENT CARE CLINIC, CHARLESTON, WV 25304
(304) 388-5590
(304) 388-8238
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
24019
WV
207RI0011X
Interventional Cardiology Physician
Primary
24019
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810017834
—
WV
01
—
P01108428
RAILROAD MEDICAR
WV
Enumeration date
07/24/2007
Last updated
07/15/2020
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