1457319220 NPI number — WAHEED A KHAN MD

Table of content: DENISE LYNNE DAVIS PMHNP (NPI 1346820388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457319220 NPI number — WAHEED A KHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
WAHEED
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1457319220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
MOUNTANIEER HEALTHCAE ,PLLC
Provider Second Line Business Mailing Address:
115 SUMMERS HOSPITAL ROAD
Provider Business Mailing Address City Name:
HINTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-466-2933
Provider Business Mailing Address Fax Number:
304-466-2932

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 TERRACE STREET
Provider Second Line Business Practice Location Address:
DOCTORS OFFICE 105
Provider Business Practice Location Address City Name:
HINTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-466-2933
Provider Business Practice Location Address Fax Number:
304-466-2932
Provider Enumeration Date:
05/02/2006

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:  18163 , 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)





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