Provider Demographics
NPI:1093825432
Name:MAHMOUD, KHALID (MD)
Entity Type:Individual
Prefix:
First Name:KHALID
Middle Name:
Last Name:MAHMOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 HOSPITAL PLZ
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-8552
Mailing Address - Country:US
Mailing Address - Phone:304-269-4252
Mailing Address - Fax:304-269-5443
Practice Address - Street 1:66 HOSPITAL PLAZA SUITE 104
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452
Practice Address - Country:US
Practice Address - Phone:304-269-4252
Practice Address - Fax:304-269-5443
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19855207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6000184000Medicaid
G95261Medicare UPIN
WV6000184000Medicaid