1285861823 NPI number — DR. NAGHMA RAIS KHAN M.D.

Table of content: DR. NAGHMA RAIS KHAN M.D. (NPI 1285861823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285861823 NPI number — DR. NAGHMA RAIS KHAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
NAGHMA
Provider Middle Name:
RAIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285861823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1991 SPROUL RD
Provider Second Line Business Mailing Address:
SUITE 625
Provider Business Mailing Address City Name:
BROOMALL
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19008-3512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-421-1669
Provider Business Mailing Address Fax Number:
610-325-0459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 SPROUL RD
Provider Second Line Business Practice Location Address:
SUITE 625
Provider Business Practice Location Address City Name:
BROOMALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19008-3512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-421-1669
Provider Business Practice Location Address Fax Number:
610-325-0459
Provider Enumeration Date:
06/22/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD445860 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 440771 . This is a "MLHC MEDICARE AA #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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