1184976631 NPI number — KHAN MEDICAL ASSOCIATE

Table of content: (NPI 1184976631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184976631 NPI number — KHAN MEDICAL ASSOCIATE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHAN MEDICAL ASSOCIATE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1184976631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 SEIGFRIED STREET
Provider Second Line Business Mailing Address:
PO BOX 206
Provider Business Mailing Address City Name:
ARONA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-217-0782
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PENN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15221-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-242-8860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
ABDUL
Authorized Official Middle Name:
Q
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
412-242-8860

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  SP012275 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3140N1450X , with the licence number: SP012275 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 315D00000X , with the licence number: SP012275 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: SP012275 , 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)