Provider Demographics
NPI:1043274830
Name:SANKARI, MOHAMAD RIAD (MD)
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:RIAD
Last Name:SANKARI
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 1:400 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-2117
Mailing Address - Country:US
Mailing Address - Phone:304-442-2894
Mailing Address - Fax:304-442-1259
Practice Address - Street 1:401 DIVISION ST STE 205
Practice Address - Street 2:
Practice Address - City:SOUTH CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25309-1455
Practice Address - Country:US
Practice Address - Phone:304-342-0821
Practice Address - Fax:304-345-6679
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17712207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0077407000Medicaid
F91384Medicare UPIN
WV0077407000Medicaid
WVSA0855472Medicare PIN