Healthcare Provider Details

I. General information

NPI: 1568441285
Provider Name (Legal Business Name): M. ZAFRULLAH KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 CHESTERFIELD AVE SUITE 300
CHARLESTON WV
25304-1066
US

IV. Provider business mailing address

2335 CHESTERFIELD AVE SUITE 300
CHARLESTON WV
25304-1066
US

V. Phone/Fax

Practice location:
  • Phone: 304-343-7576
  • Fax: 304-343-3273
Mailing address:
  • Phone: 304-343-7576
  • Fax: 304-343-3273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number10084
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: