Healthcare Provider Details

I. General information

NPI: 1639306491
Provider Name (Legal Business Name): NADIA N KHAN M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 UNIVERSITY TOWN CENTRE DR
MORGANTOWN WV
26501-2421
US

IV. Provider business mailing address

1370 JOHNSON AVE STE 102
BRIDGEPORT WV
26330-1492
US

V. Phone/Fax

Practice location:
  • Phone: 855-988-2273
  • Fax:
Mailing address:
  • Phone: 681-342-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27837
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: