Provider Demographics
NPI:1790722809
Name:KHAN, FARUKH A (MD)
Entity Type:Individual
Prefix:DR
First Name:FARUKH
Middle Name:A
Last Name:KHAN
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 1:1 PLEASANT AVE
Mailing Address - Street 2:SUITE1
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-4610
Mailing Address - Country:US
Mailing Address - Phone:304-636-5426
Mailing Address - Fax:304-636-2255
Practice Address - Street 1:1 PLEASANT AVE
Practice Address - Street 2:SUITE1
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-4610
Practice Address - Country:US
Practice Address - Phone:304-636-5426
Practice Address - Fax:304-636-2255
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11826207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055952000Medicaid
WVKH0788781Medicare ID - Type UnspecifiedMEDICARE
WVD49470Medicare UPIN