Healthcare Provider Details

I. General information

NPI: 1235327404
Provider Name (Legal Business Name): MURSHID KHADER ABDEL-LATIF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MON HEALTH MEDICAL PARK DR STE 2100
MORGANTOWN WV
26505
US

IV. Provider business mailing address

2000 MON HEALTH MEDICAL PARK DR STE 2100
MORGANTOWN WV
26505-1134
US

V. Phone/Fax

Practice location:
  • Phone: 304-599-6811
  • Fax: 304-599-7159
Mailing address:
  • Phone: 304-599-6811
  • Fax: 304-599-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number17237
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number17237
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: