Provider Demographics
NPI:1023171089
Name:KHALIL, MARCIA BOHN (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:BOHN
Last Name:KHALIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 BROOKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2303
Mailing Address - Country:US
Mailing Address - Phone:304-253-1223
Mailing Address - Fax:304-253-7067
Practice Address - Street 1:1731 HARPER RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3311
Practice Address - Country:US
Practice Address - Phone:304-255-1541
Practice Address - Fax:304-253-7067
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11143207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001709417OtherBCBS
WV0094393000Medicaid
WV001709417OtherBCBS
WV0094393000Medicaid