Provider Demographics
NPI:1063417145
Name:KHAN, ATIF (MD)
Entity type:Individual
Prefix:
First Name:ATIF
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 OLD ROAD NINE ACRE CORNER
Mailing Address - Street 2:JCB SUITE 500
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-287-3547
Mailing Address - Fax:978-287-2949
Practice Address - Street 1:131 OLD ROAD NINE ACRE CORNER
Practice Address - Street 2:JCB SUITE 500
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-287-3547
Practice Address - Fax:978-287-2949
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA243890208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200026OtherLUNG
54183971800OtherWV WORKERS COMPENSATION
5727853OtherCIGNA
WV200212000Medicaid
WV236802OtherANTHEM
WV541839718105OtherBS MOUNTAIN STATE
5400143OtherCCN
VA007312997Medicaid
188426OtherCARELINK
VA245780OtherANTHEM
VA541839718101OtherBS MOUNTAIN STATE
7646497OtherAETNA
188426OtherSOUTHERN HEALTH
541839718OtherC&O
188426OtherSOUTHERN HEALTH
VA020001594Medicare ID - Type UnspecifiedTRAILBLAZER HEALTH/VAMC
54183971800OtherWV WORKERS COMPENSATION
1519679Medicare ID - Type UnspecifiedUMWA
WV200212000Medicaid