Provider Demographics
NPI:1073680393
Name:KHAN, ABDUL RAHIM (MD)
Entity type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:RAHIM
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 ANTON DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-1748
Mailing Address - Country:US
Mailing Address - Phone:203-612-7201
Mailing Address - Fax:
Practice Address - Street 1:285 ANTON DR
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-1748
Practice Address - Country:US
Practice Address - Phone:203-612-7201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071910207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32583OtherBCBS
FL32583BMedicare ID - Type Unspecified