1063417145 NPI number — ATIF KHAN MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063417145 NPI number — ATIF KHAN MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KHAN

Provider First Name:

ATIF

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1063417145

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

11/15/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

131 OLD ROAD NINE ACRE CORNER

Provider Second Line Business Mailing Address:

JCB SUITE 500

Provider Business Mailing Address City Name:

CONCORD

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01742

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

978-287-3547

Provider Business Mailing Address Fax Number:

978-287-2949

Provider First Line Business Practice Location Address:

131 OLD ROAD NINE ACRE CORNER

Provider Second Line Business Practice Location Address:

JCB SUITE 500

Provider Business Practice Location Address City Name:

CONCORD

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01742

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

978-287-3547

Provider Business Practice Location Address Fax Number:

978-287-2949

Provider Enumeration Date:

06/16/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208600000X , with the licence number:  243890 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 200026 . This is a "LUNG" identifier . This identifiers is of the category "OTHER".
• Identifier: 54183971800 . This is a "WV WORKERS COMPENSATION" identifier . This identifiers is of the category "OTHER".
• Identifier: 5727853 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 200212000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
• Identifier: 236802 . This is a "ANTHEM" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 541839718105 . This is a "BS MOUNTAIN STATE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
• Identifier: 5400143 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
• Identifier: 007312997 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 188426 . This is a "CARELINK" identifier . This identifiers is of the category "OTHER".
• Identifier: 245780 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 541839718101 . This is a "BS MOUNTAIN STATE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 7646497 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 188426 . This is a "SOUTHERN HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 541839718 . This is a "C&O" identifier . This identifiers is of the category "OTHER".