1689632036 NPI number — SHAHZAD A KHAN MD

Table of content: SHAHZAD A KHAN MD (NPI 1689632036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689632036 NPI number — SHAHZAD A KHAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHAN
Provider First Name:
SHAHZAD
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1689632036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
525 IRON STREET
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LEHIGHTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18235-1949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-379-4677
Provider Business Mailing Address Fax Number:
610-379-4678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
525 IRON STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-1949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-379-4677
Provider Business Practice Location Address Fax Number:
610-379-4678
Provider Enumeration Date:
05/03/2006

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: 2084N0400X , with the licence number:  MD111404 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X , with the licence number: MD-431649 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084S0012X , with the licence number: MD-431649 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: MD431649 , 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: 130018287 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 209784305 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102004244-001 . This is a "MEDIAL ASSISTANT" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com