Provider Demographics
NPI:1407689623
Name:KHAN, ISKANDAR (MS)
Entity type:Individual
Prefix:MR
First Name:ISKANDAR
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7787
Mailing Address - Country:US
Mailing Address - Phone:802-310-7445
Mailing Address - Fax:
Practice Address - Street 1:159 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7787
Practice Address - Country:US
Practice Address - Phone:802-310-7445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health