Healthcare Provider Details

I. General information

NPI: 1649359944
Provider Name (Legal Business Name): GHASSAN HANI KANJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 J D ANDERSON DR SUITE 5A
MORGANTOWN WV
26505-4000
US

IV. Provider business mailing address

99 J D ANDERSON DR STE 5A
MORGANTOWN WV
26505-4000
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-2801
  • Fax: 304-599-6463
Mailing address:
  • Phone: 304-598-2801
  • Fax: 304-599-6463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD453818
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD453818
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number19742
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMD453818
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC1-0024495
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: