Provider Demographics
NPI:1639306491
Name:KHAN, NADIA N (MD)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:N
Last Name:KHAN
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 1:1370 JOHNSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1492
Mailing Address - Country:US
Mailing Address - Phone:681-342-3457
Mailing Address - Fax:
Practice Address - Street 1:6040 UNIVERSITY TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-2421
Practice Address - Country:US
Practice Address - Phone:855-988-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2723148OtherHIGHMARK BLUE SHIELD
PA30136631OtherAMERIHEALTH MERCY - WSGER
PA1611056 (SPEC)OtherGATEWAY
PAP011606OtherGATEWAY
PA30139611OtherAMERIHEALTH MERCY-YHCHC
PA102754226Medicaid
PA1611056OtherGATEWAY
PA30136633OtherAMERIHEALTH MERCY - WSH
PA30119143OtherAMERIHEALTH MERCY - WBTH
PA418685OtherUPMC
PA2723148OtherHIGHMARK BLUE SHIELD
PA30139611OtherAMERIHEALTH MERCY-YHCHC