Provider Demographics
NPI:1780899062
Name:TANVEER, KHAN MERAJ (MD)
Entity type:Individual
Prefix:DR
First Name:KHAN
Middle Name:MERAJ
Last Name:TANVEER
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 1:670 KILLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-2428
Mailing Address - Country:US
Mailing Address - Phone:404-668-6942
Mailing Address - Fax:
Practice Address - Street 1:40 COMMERCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-3874
Practice Address - Country:US
Practice Address - Phone:304-292-7535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV22922208D00000X
WVWV 22922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010811Medicaid
WV001973506OtherMS BCBS
WV3810010811Medicaid