Healthcare Provider Details

I. General information

NPI: 1609080761
Provider Name (Legal Business Name): AMIRA I KHOKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 05/12/2022
Certification Date: 01/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NEW HOPE RD STE 3
PRINCETON WV
24740-2287
US

IV. Provider business mailing address

PO BOX 9124
MORGANTOWN WV
26506-9124
US

V. Phone/Fax

Practice location:
  • Phone: 304-487-6065
  • Fax: 304-425-5420
Mailing address:
  • Phone: 304-293-6307
  • Fax: 304-293-1216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number23678
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0093503
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: