Healthcare Provider Details

I. General information

NPI: 1801383369
Provider Name (Legal Business Name): NEIL KHURANA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 COLLIERS WAY STE 506
WEIRTON WV
26062-5054
US

IV. Provider business mailing address

651 COLLIERS WAY STE 300
WEIRTON WV
26062-5058
US

V. Phone/Fax

Practice location:
  • Phone: 304-723-3600
  • Fax:
Mailing address:
  • Phone: 304-797-6404
  • Fax: 304-797-7894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number30575
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: