1790168409 NPI number — DR. MUHAMMAD FARHAN KHALIQ M.D.

Table of content: DR. MUHAMMAD FARHAN KHALIQ M.D. (NPI 1790168409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790168409 NPI number — DR. MUHAMMAD FARHAN KHALIQ M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHALIQ
Provider First Name:
MUHAMMAD
Provider Middle Name:
FARHAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1790168409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
830 PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
WOMEN AND CHILDREN'S MEDICAL STAFF OFFICE, SUITE 103
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25302-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-388-2525
Provider Business Mailing Address Fax Number:
304-388-2537

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1615 DELAWARE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98632-2367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-501-3601
Provider Business Practice Location Address Fax Number:
360-442-6843
Provider Enumeration Date:
06/30/2015

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:  320937 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD61376943 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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