Provider Demographics
NPI:1215253935
Name:KHAN PEDIATRICS INC
Entity type:Organization
Organization Name:KHAN PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD, FAAP
Authorized Official - Phone:302-449-5791
Mailing Address - Street 1:103 E MAIN ST
Mailing Address - Street 2:KHAN PEDIATRICS INC.
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-5906
Mailing Address - Country:US
Mailing Address - Phone:302-449-5791
Mailing Address - Fax:302-449-5794
Practice Address - Street 1:103 E MAIN ST
Practice Address - Street 2:KHAN PEDIATRICS INC.
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5906
Practice Address - Country:US
Practice Address - Phone:302-449-5791
Practice Address - Fax:302-449-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-20
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1215253935Medicaid