Basic Information
| Provider Information | |||||||||
| NPI: | 1649234121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHALID | ||||||||
| FirstName: | AHMED | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3415 MACCORKLE AVE SE | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043888380 | ||||||||
| FaxNumber: | 3043888395 | ||||||||
| Practice Location | |||||||||
| Address1: | 3100 MACCORKLE AVE SE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253041223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043888380 | ||||||||
| FaxNumber: | 3043888388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 12/14/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 21624 | WV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | P00160558 | 01 | RAILROAD MEDICARE | OTHER | 3810000577 | 05 | WV | MEDICAID |