Provider Demographics
NPI:1235106832
Name:KHOSROVI, HOUMAN H (MD)
Entity Type:Individual
Prefix:
First Name:HOUMAN
Middle Name:H
Last Name:KHOSROVI
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 1:1212 GARFIELD AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3207
Mailing Address - Country:US
Mailing Address - Phone:304-865-3600
Mailing Address - Fax:304-865-3700
Practice Address - Street 1:407 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1615
Practice Address - Country:US
Practice Address - Phone:304-865-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18290207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2146476Medicaid
WV0089271000Medicaid
OHG36219Medicare UPIN
OH2146476Medicaid
OHKH0876474Medicare PIN
WVKH0876475Medicare PIN