Healthcare Provider Details

I. General information

NPI: 1487818167
Provider Name (Legal Business Name): AMIR R. KHORSHAD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVENUE SE HOSPITALIST PROGRAM
CHARLESTON WV
25304
US

IV. Provider business mailing address

415 MORRIS STREET SUITE 304
CHARLESTON WV
25301
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-5848
  • Fax: 304-388-9654
Mailing address:
  • Phone: 304-388-7782
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.003090RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number50.003090RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: