Basic Information
| Provider Information | |||||||||
| NPI: | 1639306491 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHAN | ||||||||
| FirstName: | NADIA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1370 JOHNSON AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | BRIDGEPORT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 263301492 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6813423457 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6040 UNIVERSITY TOWN CENTRE DR | ||||||||
| Address2: | |||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265012421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8559882273 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2009 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 27837 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2723148 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 30136631 | 01 | PA | AMERIHEALTH MERCY - WSGER | OTHER | 1611056 (SPEC) | 01 | PA | GATEWAY | OTHER | P011606 | 01 | PA | GATEWAY | OTHER | 30139611 | 01 | PA | AMERIHEALTH MERCY-YHCHC | OTHER | 102754226 | 05 | PA | MEDICAID | 1611056 | 01 | PA | GATEWAY | OTHER | 30136633 | 01 | PA | AMERIHEALTH MERCY - WSH | OTHER | 30119143 | 01 | PA | AMERIHEALTH MERCY - WBTH | OTHER | 418685 | 01 | PA | UPMC | OTHER |