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General NPI Number Information
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NPI Number | 1528089158
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Entity Type | Individual
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Provider Name | ALI A KHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 2 HARTMAN PLZ
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City | BUCKHANNON
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State | WV
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Zip | 26201-2230
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Country | US
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Telephone | 304-471-3400
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Fax | 304-471-3402
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Provider Business Mailing Address
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Address Line | 527 MEDICAL PARK DRIVE SUITE 204
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City | BRIDGEPORT
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State | WV
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Zip | 26330
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Country | US
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Telephone | 304-933-3800
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Fax | 304-933-3815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 17611
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License Number State | WV
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