Provider Demographics
NPI:1457976292
Name:KHAN, ALI NAUMAN (MD)
Entity type:Individual
Prefix:MR
First Name:ALI NAUMAN
Middle Name:
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 1:197 ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2930
Mailing Address - Country:US
Mailing Address - Phone:413-664-5710
Mailing Address - Fax:413-458-8182
Practice Address - Street 1:197 ADAMS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2930
Practice Address - Country:US
Practice Address - Phone:413-664-5710
Practice Address - Fax:413-458-8182
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-08
Last Update Date:2023-10-26
Deactivation Date:2022-01-18
Deactivation Code:
Reactivation Date:2022-04-13
Provider Licenses
StateLicense IDTaxonomies
390200000X
MAMA1015302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty