Provider Demographics
NPI:1194766980
Name:KHAN OBSTETRICS & GYNECOLOGY ASSOCIATES, PA
Entity type:Organization
Organization Name:KHAN OBSTETRICS & GYNECOLOGY ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-735-8720
Mailing Address - Street 1:888 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4148
Mailing Address - Country:US
Mailing Address - Phone:302-735-8720
Mailing Address - Fax:302-735-8724
Practice Address - Street 1:888 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4148
Practice Address - Country:US
Practice Address - Phone:302-735-8720
Practice Address - Fax:302-735-8724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2002104386207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000015028Medicaid
DE1000015028Medicaid