Healthcare Provider Details

I. General information

NPI: 1023337961
Provider Name (Legal Business Name): SAJEEL REHMAT KHAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DR STE B500
HUNTINGTON WV
25701-3655
US

IV. Provider business mailing address

10 RIVERWALK DR
ONA WV
25545-9587
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1787
  • Fax:
Mailing address:
  • Phone: 978-944-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number242139
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number29010
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: