Provider Demographics
NPI:1215743380
Name:KHAN, MOMINA (PA-C)
Entity type:Individual
Prefix:
First Name:MOMINA
Middle Name:
Last Name:KHAN
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Gender:
Credentials:PA-C
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Mailing Address - Street 1:360 US HIGHWAY 1 BYP UNIT 102
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7105
Mailing Address - Country:US
Mailing Address - Phone:603-410-6700
Mailing Address - Fax:603-319-8308
Practice Address - Street 1:70 GOLD STAR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-2812
Practice Address - Country:US
Practice Address - Phone:508-426-9002
Practice Address - Fax:508-426-9070
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2025-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant