Healthcare Provider Details

I. General information

NPI: 1235106832
Provider Name (Legal Business Name): HOUMAN H KHOSROVI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 MAIN ST STE 2
BELPRE OH
45714-1615
US

IV. Provider business mailing address

1212 GARFIELD AVE SUITE 300
PARKERSBURG WV
26101-3207
US

V. Phone/Fax

Practice location:
  • Phone: 304-865-3600
  • Fax:
Mailing address:
  • Phone: 304-865-3600
  • Fax: 304-865-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number35.076601
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: