1639306491 NPI number — NADIA N KHAN M.D

Table of content: NADIA N KHAN M.D (NPI 1639306491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639306491 NPI number — NADIA N KHAN M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
NADIA
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639306491
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1370 JOHNSON AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIDGEPORT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26330-1492
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
681-342-3457
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6040 UNIVERSITY TOWN CENTRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26501-2421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-988-2273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  27837 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2723148 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30136631 . This is a "AMERIHEALTH MERCY - WSGER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1611056 (SPEC) . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P011606 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30139611 . This is a "AMERIHEALTH MERCY-YHCHC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 102754226 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1611056 . This is a "GATEWAY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30136633 . This is a "AMERIHEALTH MERCY - WSH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30119143 . This is a "AMERIHEALTH MERCY - WBTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 418685 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".