Healthcare Provider Details

I. General information

NPI: 1780899062
Provider Name (Legal Business Name): KHAN MERAJ TANVEER M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 COMMERCE DR SUITE 101
WESTOVER WV
26501-3874
US

IV. Provider business mailing address

670 KILLARNEY DR
MORGANTOWN WV
26505-2428
US

V. Phone/Fax

Practice location:
  • Phone: 304-292-7535
  • Fax:
Mailing address:
  • Phone: 404-668-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberWV22922
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberWV 22922
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: