Healthcare Provider Details

I. General information

NPI: 1063669463
Provider Name (Legal Business Name): HUSSEIN E EL-KHATIB,MD,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 DIVISION ST SUITE 204
S CHARLESTON WV
25309-1455
US

IV. Provider business mailing address

401 DIVISION ST SUITE 204
S CHARLESTON WV
25309-1455
US

V. Phone/Fax

Practice location:
  • Phone: 304-767-7850
  • Fax: 304-767-7855
Mailing address:
  • Phone: 304-767-7850
  • Fax: 304-767-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number17771
License Number StateWV

VIII. Authorized Official

Name: HUSSEIN E EL-KHATIB
Title or Position: PHYSICIAN
Credential: MD
Phone: 304-767-7850