Provider Demographics
NPI:1649234121
Name:KHALID, AHMED A (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:A
Last Name:KHALID
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 1:3415 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1334
Mailing Address - Country:US
Mailing Address - Phone:304-388-8380
Mailing Address - Fax:304-388-8395
Practice Address - Street 1:3100 MACCORKLE AVE SE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1223
Practice Address - Country:US
Practice Address - Phone:304-388-8380
Practice Address - Fax:304-388-8388
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21624207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00160558OtherRAILROAD MEDICARE
WV3810000577Medicaid
KH4144361Medicare ID - Type Unspecified
P00160558Medicare PIN
P00160558OtherRAILROAD MEDICARE
G43601Medicare UPIN
KH4144362Medicare PIN