Provider Demographics
NPI:1609080761
Name:KHOKAR, AMIRA I (MD)
Entity Type:Individual
Prefix:DR
First Name:AMIRA
Middle Name:I
Last Name:KHOKAR
Suffix:
Gender:F
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:PO BOX 9124
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9124
Mailing Address - Country:US
Mailing Address - Phone:304-293-6307
Mailing Address - Fax:304-293-1216
Practice Address - Street 1:608 NEW HOPE RD STE 3
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2287
Practice Address - Country:US
Practice Address - Phone:304-487-6065
Practice Address - Fax:304-425-5420
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV23678208000000X
MDD0093503208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03639347Medicaid
NYA400088857Medicare PIN