Healthcare Provider Details

I. General information

NPI: 1457319220
Provider Name (Legal Business Name): WAHEED A KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 TERRACE STREET DOCTORS OFFICE 105
HINTON WV
25951
US

IV. Provider business mailing address

MOUNTANIEER HEALTHCAE ,PLLC 115 SUMMERS HOSPITAL ROAD
HINTON WV
25951
US

V. Phone/Fax

Practice location:
  • Phone: 304-466-2933
  • Fax: 304-466-2932
Mailing address:
  • Phone: 304-466-2933
  • Fax: 304-466-2932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number18163
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: